A 74-year-old male patient with no relevant medical or family history.
She was admitted to the emergency service in September 2007 due to abdominal pain in the right hypochondrium, intestinal aphthousmia, without vomiting or alterations of the intestinal transit.
The physical examination was inconclusive so laboratory tests and images were requested.
The analysis highlighted a C-reactive protein of 7.2 mg/dL, leukocyte count 80/mm3, with 67.8% neutrophils and normal amylasemia.
An echotomography showed a complex solid-cystic lesion of about 5 cm in the left lobe of the liver.
Abdominal computed tomography revealed probable acute hepatic failure and focal abscess suspect.
Cholecystectomy and biopsy of the hepatic lesion were performed.
No other abdominal lesions were identified during the surgical exploration.
The pathological study showed a liver metastasis of neuroendocrine tumor with consistent immunohistochemistry.
Whole-body 18FDG PET/CT was requested, which showed only physiological uptake in various organs without observing a significant increase in glucose metabolism of the metastasis of the left lobe of the liver compared to the rest of the liver parenchyma.
Searching for the tumor of origin was classified as normal.
Three months later a PET/CT scan was performed using the new radiopharmaceutical 68Ga-DOTATATE (CGM Nuclear, Santiago-Chile) recently incorporated into our center.
The quality control of the product showed a radiochemical purity exceeding 99%.
Settlement by e.v.
111 MBq (3 mCi) of the radiotracer.
Fifty minutes later, whole-body 3D PET/CT images were recorded in a Biograph 6 HiRez P3D apparatus (Siemens Medical Systems, USA).
The examination showed, in addition to intense uptake of the radiopharmaceutical in the metastasis of the left hepatic lobe and a second focus of overexpression of SST receptors located in a loop of distal ileum in the region of the ileoceal valve.
No other pathological foci were found.
1.
The patient underwent a new surgery by subcostal laparotomy, identifying a 16 mm nodule in the terminal ileum, located at the ileocecal valve, without macroscopic regional extension.
The terminal ileum, cecum and cecal appendix were resected by means of an extended subcostal laparotomy.
In the same act liver metastases were removed by left hepatectomy.
A second 8 mm metastasis of segment VII of the liver that is resected in wedge was identified as intraoperative findings.
Pathology confirmed a low grade neuroendocrine carcinoma of the terminal ileum of 16 mm with low wall thickness and lymphovascular penetration, 6 regional lymph nodes without tumor and 2 hepatic metastases of carcinoma also known grade 4.
