Ability of Somatostatin Receptor Scintigraphy to Identify Patients with Gastric Carcinoids: A Prospective Study

Ability of Somatostatin Receptor Scintigraphy to Identify Patients with Gastric Carcinoids: A Prospective Study

Fathia Gibril, James C. Reynolds, Irina A. Lubensky, Praveen K. Roy, Paolo L. Peghini, John L. Doppman and Robert T. Jensen

Digestive Diseases Branch, National Institute of Diabetes and Digestive Kidney Diseases; Nuclear Medicine and Diagnostic Radiology Departments, Warren Grant Magnuson Clinical Center; and Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

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FIGURE 1. Example of focal and diffuse gastric localization on SRS in patient with ZES, MEN-1, and multiple gastric carcinoids with carcinoid syndrome. Before total gastrectomy, transverse view (A) and sagittal view (B) showed diffuse and focal uptake in stomach. After total gastrectomy, gastric localization was no longer seen on SRS on either transverse view (C) or sagittal view (D). This patient had ZES of 16 y duration, and gastric carcinoid was diagnosed 10 y after disease onset. Upper gastrointestinal endoscopy before total gastrectomy showed multiple large gastric mucosal nodules. Histologic examination after gastrectomy showed numerous carcinoids in stomach and severe linear and micronodular hyperplasia of gastric ECL cells with dysplastic changes. Mean fasting serum gastrin level was 49,000 pg/mL (normal value is <200 pg/mL).

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FIGURE 2. Example of diffuse gastric localization on SRS in patient with ZES without MEN-1 or gastric carcinoid. Coronal view (A) and sagittal view (B) of SRS show diffuse uptake in stomach. This patient had ZES of 15 y duration. Upper gastrointestinal endoscopic findings were unremarkable except for hypertrophic gastric folds. Histopathology of 2 random Jumbo Cup biopsy (Pauldrach) samples from greater curvature showed linear and diffuse hyperplasia of gastric ECL cells. Mean fasting serum gastrin level was 250 pg/mL (normal level is <200 pg/mL).

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FIGURE 3. Example of diffuse gastric localization on SRS in patient with ZES with MEN-1 and multiple gastric carcinoids. Coronal view (A) and sagittal view (B) of SRS showed diffuse uptake in stomach. This patient had ZES of 15 y duration. Gastric carcinoid was diagnosed 7 y after disease onset. Upper gastrointestinal endoscopy showed multiple gastric mucosal nodules. Histology of 1 gastric nodule showed carcinoid and diffuse, linear hyperplasia of gastric ECL cells. Patient did not have carcinoid syndrome. Mean fasting serum gastrin level was 1500 pg/mL (normal level is <200 pg/mL).

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FIGURE 4. Example of diffuse gastric localization on SRS in patient with ZES without MEN-1 or gastric carcinoid. Coronal view (A) and transverse view (B) of SRS showed diffuse uptake in stomach. This patient had ZES of 11 y duration, and mean fasting serum gastrin level was 2900 pg/mL (normal level is <200 pg/mL). Upper gastrointestinal endoscopic findings were unremarkable except for prominent gastric folds. Histology of 2 random Jumbo Cup biopsy (Pauldrach) samples from gastric body on greater curvature showed moderate linear hyperplasia of ECL cells with dysplastic changes.

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FIGURE 5. Example of diffuse gastric localization on SRS in patient with ZES with MEN-1 and gastric carcinoid. Coronal view (A), transverse view (B), and sagittal view (C) of SRS showed diffuse uptake in stomach. This patient had ZES of 20 y duration as part of MEN-1 syndrome, and gastric carcinoid was diagnosed 17 y after onset of disease. Gastric carcinoid was diagnosed by biopsy of gastric nodule. Patient did not have carcinoid syndrome. Mean fasting serum gastrin level was 3862 pg/mL (normal level is <200 pg/mL).