Neuroendocrine carcinoma (response to TARE)

Case submitted by Nazim Coskun

60-year-old female

Liver biopsy → neuroendocrine carcinoma metastasis (Ki-67 30%)

IHC: p53 mutation and increased ATRX expression

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Multiple liver lesions showing increased FDG uptake (SUVmax: 11.27). Metastatic periportal lymhadenopathy also showed increased FDG uptake (SUVmax: 11.46).

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Hepatic perfusion scintigraphy with MAA particles (150 MBq) delivered to the right hepatic artery showed increased perfusion in all lesions. Resin microspheres loaded with 1 GBq 90Y injected to the same region demonstrated a similar distribution with MAA scan.

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Follow-up FDG PET at 8 weeks after TARE showed complete metabolic response in all targeted lesions. Metastatic periportal lymhadenopathy showed increased FDG uptake (SUVmax: 7.53).

Case Notes

Poorly differentiated neuroendocrine carcinomas (NECs) show decreased uptake of radiolabelled somatostatin anologs due to loss of somatostatin receptor expression, and demonstrate incresed FDG avidity due to increased mitotic activity. Transarterial radioembolization offers a safe and effective treatment approach for liver metastases of NECs.

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Updated on Mar 30, 2024