CASE OF THE WEEK – “Intrapancreatic true NET lesion in the tail of the pancreas VS splenunculi - The role of colloid liver spleen hybrid SPECT CT scintigraphy“ by Dr. Shekhar Shikare, HOD & Consultant, Nuclear Medicine & Dr. Akhilesh Sapra, Specialist, Gastrointestinal Surgeon, NMC Royal Hospital Sharjah

CASE OF THE WEEK – “Intrapancreatic true NET lesion in the tail of the pancreas VS splenunculi - The role of colloid liver spleen hybrid SPECT CT scintigraphy“ by Dr. Shekhar Shikare, HOD & Consultant, Nuclear Medicine & Dr. Akhilesh Sapra, Specialist, Gastrointestinal Surgeon, NMC Royal Hospital Sharjah

Case

49 years old gentleman with history of upper abdominal pain. On evaluation he was found to have duodenal endocrine tumor.

Biochemical parameters

Sr gastrin 141 pg.ml (0-115), Insulin random 23.44 mIU/L (3.0-25.0), Chromogranin A 724.8 ng/ml ( 0.0-101.8),

USG abdomen- small hiatus hernia duodenal polypoidal lesion? submucosal, antral erosions.

CONTRAST CT ABDOMEN AND PELVIS

Small arterial phase enhancing lesion seen in in upper/outer wall of the duodenal bulb with minimally enhancing adjacent lymph node in supra pancreatic location. Pancreas is normal in size, shape and attenuation. No focal lesions are seen.

Biopsy- Neuroendocrine tumor, grade 2 duodenal polyp.

68 DOTATATE PET CT SCAN

Figure 1 68 DOTATATE PET CT SCAN

Colloid liver spleen hybrid SPECT CT scintigraphy to exclude/confirm splenunculi.

99mTc COLLOID LIVER SPLEEN PLANAR & HYBRID SPECT-CT SCAN

Liver spleen scan finding are unremarkable with no appreciation of any extra splenic tracer uptakes (splenule/splenunculus) even on hybrid SPECT CT images (figure 2 & 3)


Figure 2 99mTc colloid liver spleen images

Patient underwent duodenal local rescetion with lymphdectomy with spleen preserving distal pancreatomy.

Histopaholgy- Pancreatic neuroendcrine tumor, pT1(2),G1- Distal pancreatomy, margin free of tumor. Lymphvascular invasion absent.

Teaching point

Hybrid SPECT-CT liver spleen colloid scintigraphy provided both the antomical and functional information in this case as described above and was helpful in surgical decicion making.