History:  A 43-year-old caucasian female started noticing swelling of her feet and was started initially on
hydrochlorothiazide with no benefit. She was also given IV diuretics without any significant benefits. At the same time, she started developing symptoms of numbness in hands and legs, worsening of acne, weight gain of about 20 pounds in two to three months time, difficulty getting up from a chair with muscle weakness, worsening of hirsutism with the development of black thick hair under her chin, easy bruising
without trauma. She also complains of shortness of breath and palpitations for which she was referred to a cardiologist and had a stress test and echocardiogram done which were essentially normal.  She was screened for the Cushing's syndrome with overnight dexamethasone suppression test, low-dose dexamethasone and random cortisol and ACTH levels which strongly suggested ACTH dependent
Cushing syndrome.

PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 112/54, pulse 96, weight 206.
GENERAL: Patient with facial plethora, resolving acne and black thick hair under the chin.
NECK: The buffalo hump was felt.
EXTREMITIES: +2 pedal edema.
NEUROLOGICAL: Reflexes were normal. Proximal muscle weakness with difficulty getting up from squatting position

IMPRESSION: 1. FOCUS OF INCREASED UPTAKE WITHIN THE RIGHT HILAR REGION, WHICH CORRELATES TO MASS SEEN ON PRIOR CT. THIS IS COMPATIBLE WITH A NEUROENDOCRINE TUMOR MOST LIKELY A CARCINOID. 2. NO OTHER AREAS OF INCREASED UPTAKE TO SUGGEST METASTATIC DISEASE

TUMOR LOCALIZATION SPECT SERIES HISTORY: 42-year-old female with Cushing disease. TECHNIQUE: 5.9mCi indium-111 pentetreotide was administered intravenously. Planar and SPECT/CT imaging was performed through the chest and abdomen. FINDINGS: A focus of increased uptake is seen within the right hilar region, which correlates with mass seen on prior CT of the chest. No other areas of increased uptake are seen within the remainder of the lung parenchyma or mediastinum. No focal areas of increased uptake are seen within the liver or other intra-abdominal organs.

PREOPERATIVE NOTE:
Ms. Moon is a 43-year-old, young lady diagnosed with carcinoid tumor of the right lung which was discovered as part of the workup for Cushing syndrome. She is a found to have this lesion in the lower
lobe of the right lung. Octreotide nuclear scan showed high uptake in that same lesion and no uptake anywhere else. A CT scan of the chest and abdomen suggested some liver lesion that appears to be
nonfunctioning on the octreotide scan. She was referred for surgical treatment of the pulmonary neoplasm.

PREOPERATIVE DIAGNOSIS:
Right lung tumor most likely carcinoid tumor with Cushing syndrome.

PROCEDURE:
Right thoracotomy and right lung lower lobectomy

 

FINDINGS:
The neoplasm measured about 3 cm x 2 cm, and it occupied the right lower lobe anterior segment. The resection margin of the bronchus was free of tumor involvement.

Pathology Report:  A) Lung, Right Lower Lobe, Lobectomy: Carcinoid Tumor; All Margins Negative for Tumor.  B)  Lymph nodes biopsy: negative for tumor

BACK

© 2006 Nuclear Education Online

Images courtesy of University of Arkansas for Medical Sciences Dept of Nuclear Medicine.