J Thorac Cardiovasc Surg 2004;128:801
© 2004 The American Association for Thoracic Surgery
Thymic neuroendocrine carcinoma (carcinoid): What if octreotide scanning is negative?
Donald Whitaker, FRCS(ED)
Department of Cardiothoracic Surgery, Guy's Hospital, London SE1 9RT, United Kingdom
To the Editor:
I was interested to read Filosso and colleagues' recent description1 of a case of thymic neuroendocrine carcinoma (carcinoid) successfully treated with neoadjuvant radiotherapy and chemotherapy and the somatostatin (sst2) analog octreotide. Filosso and colleagues1 stated, "Neuroendocrine tumors, including thymic tumors, express sst2 at immunohistochemistry."Other than octreotide scanning and computed tomography or magnetic resonance imaging (which were clearly useful in their case), they did not discuss other methods of localizing these tumors. This gives the impression that all thymic neuroendocrine carcinomas may be detected with octreotide scanning. However, although others have also reported octreotide scanning to be of use in detecting thymic neuroendocrine tumors,2,3 this is not always the case. A recent case series found none of 12 cases to have positive results for sst2 receptors.4 Thus if results of octreotide scanning are negative, other methods may be needed for accurately localization of both the primary tumor and any metastases to treat cases of thymic neuroendocrine carcinoma as successfully as did Filosso and colleagues.1 Other such methods that may be useful are positron emission tomographic scanning with fluorodeoxyglucose labeled with fluorine 18 and scanning with metaiodobenzylguanidine labeled with iodine 123.4,5 In 2 cases briefly reported from Guy's Hospital,5 1 patient underwent octreotide scanning, with negative results. However, positron emission tomographic scanning localized metastases, and radiolabeled metaiodobenzylguanidine was used to treat these metastases.
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References
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- Filosso PL, Actis Dato GM, Ruffini E, Bretti S, Ozzello F, Mancuso M. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): report of a successful case and review of the literature. J Thorac Cardiovasc Surg.2004;127:1215-1219.[Free Full Text]
- Nilsson O, Kolby L, Wangberg B, Wigander A, Billig H, William-Olsson L, et al. Comparative studies on the expression of somatostatin receptor subtypes, outcome of octreotide scintigraphy and response to octreotide treatment in patients with carcinoid tumours. Br J Cance.1998;77:632-637.
- Silva F, Vazquez-Selles J, Aguilo F, Vazquez G, Flores C. Recurrent ectopic adrenocorticotropic hormone producing thymic carcinoid detected with octreotide imaging. Clin Nucl Med.1999;24:109-110.[Medline]
- Tiffet O, Nicholson AG, Ladas G, Sheppard MN, Goldstraw P. A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest.2003;124:141-146.[Abstract/Free Full Text]
- Whitaker D, Dussek J. The use of PET scanning in neuroendocrine tumors of the thymus. [letter] Ches.2004;125:2368-2369.
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