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Carcinoid tumor of the appendix.PET scan results
Hi everyone i was diagnosed w a carcinoid tumor of the appendx. It was removed 8 m again along w my rt colon.
Fast forward I had a pet scan and this is what it show. I am scared and would appreciate all the help. Do you think I have metastasis?
EXAM: NM PET/CT CU64 DOTATATE
DATE: 12/9/2022
INDICATION: Appendiceal well-differentiated neuroendocrine tumor.
ADDITIONAL HISTORY: As per medical chart, Appendiceal well-differentiated neuroendocrine tumor, stage II pT3NxM0. 2/10/2022: S/P robotic?appendectomy. 3/28/22: S/P laparoscopic rt hemicolectomy. Thyroid, left middle, fine needle aspiration; smears and
thin prep: Benign follicular nodule with cystic change.
TECHNIQUE: The patient was intravenously injected with 4.60 mCi of Cu-64 Dotatate via a right antecubital vein at 8:20. PET/CT scanning began at 9:44. Patient weight was reported as 70.76 kg. Images were acquired from the skull base to the upper thighs.
The low-dose noncontrast CT data was used for attenuation correction and anatomic localization. Reconstructed images in the axial, sagittal and coronal views were interpreted. Quantitation was performed using maximum standardized uptake values (SUVmax).
COMPARISON: FDG PET/CT dated 7/7/2021.
CORRELATION: CT abdomen on 3/1/2022 and MR abdomen on 1/31/2022.
FINDINGS:
Background hepatic activity: SUV 8.6.
Background splenic activity: SUV 26.6.
Head/Neck:
There is physiologic distribution of the radiotracer in the imaged portions of the head and neck. No radiotracer avid cervical lymphadenopathy.
There is focal increased radiotracer uptake in the left thyroid gland, SUV 4.1, corresponding to a 1.3 cm hypoattenuating nodule.
There is mild ethmoid and maxillary sinus mucosal thickening.
Chest:
There is physiologic distribution of the radiotracer within the chest without suspicious radiotracer avid mediastinal, hilar or axillary lymphadenopathy. There is mild residual thymic tissue in the anterior mediastinum.
Limited assessment of the lungs due to low dose, thick slice, low lung volume technique obtained during shallow breathing demonstrates atelectatic changes at the lung bases. There are no radiotracer avid pulmonary nodules identified. There is no
pericardial or pleural effusion.
Abdomen/Pelvis:
Postsurgical changes of right hemicolectomy without suspicious radiotracer uptake within the operative bed.
There is focal radiotracer uptake in the gallbladder fossa/gallbladder SUV 12.1 which may represent physiologic excretion, however attention on follow-up is recommended. Allowing for this there is no focal suspicious radiotracer uptake within the liver.
There is no abnormal radiotracer uptake within the spleen, pancreas or adrenal glands.
Physiologic activity is seen within the renal collecting systems, ureters and urinary bladder which limits assessment for focal underlying radiotracer avid lesions in these areas.
There is variable nonspecific radiotracer uptake throughout the bowel.
There is no suspicious radiotracer avid lymphadenopathy in the abdomen or pelvis. There are subcentimeter inguinal lymph nodes with mild radiotracer uptake, SUV 1.6, likely reactive in nature.
Musculoskeletal:
There is no abnormal radiotracer activity seen within the osseous structures. There is asymmetric focal uptake in the posterior right iliac bone, SUV 2.8, without definite CT correlate.
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HugInterested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.
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Hello @rice099 and welcome to the NETs discussion on Mayo Clinic Connect. I have moved your post to this discussion group so that you could meet with others who have had NETs in the appendix. I'm glad that you found this forum. It is good to be able to connect with others who are also dealing with this rare type of cancer.
You are right, Prilosec is a Proton Pump Inhibitor (PPI) medication, and its use can cause the Chromogranin number to be artificially high. However, there are other lab tests that can be done to determine NETs/carcinoid activity. Blood tests that show the Serotonin level and a 24-hour-urine test that can also tests the Serotonin level can be done. Have you had these lab tests?
There is a sophisticated scan, 68 GA Dotatate PET scan, that can also be used to show NET activity in the body. Here is a discussion on Mayo Connect that will explain how this scan is preferable to other scans in detecting NETs.
--68 GA Dotatate PET
https://connect.mayoclinic.org/discussion/68ga-dotatate-positron-emission-tomography-pet-now-at-mayo-clinic/
How are you feeling, @rice099? Are you having any carcinoid syndrome symptoms? (This would include facial flushing and diarrhea.)
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1 ReactionFirst time here and would appreciate any info from folks with a similiar issue. I had a carcinoid tumor successfully removed from my left lung in 1996 - even before they classified it as cancer. Went to the ER with appendicitis last September. Scan showed swollen appendix with signifigant inflammation in the surrounding area. Pancreas, liver, lungs, etc all appeared normal. Decision was made to treat with antibiotics and make a decision on surgery later. Chromogranin was 457. Colonoscopy was recommended which will be done next month. Dr. seems to belive there is another extremely slow growing carcincoid tumor in the appendix. I understand Prilosec which I've been taking for years can cause a false positive. Has anyone else experienced anything like this?
Hello @riffieli,
Thinking about you and wondering, have you had the MRI yet? Feel free to post any questions you might have when the results come back.
I appreciate all your comments btw!!! Ty.
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1 ReactionI’m worried about the gallbladder up take and the rt hip uptake
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1 ReactionSo sad what the medical field has become.
Hello, @riffieli
Thank you for sharing this with us and let me tell you this, no matter what your situation is, don’t stress yourself out, you are not alone. When i was diagnosed with small bowel carcinoma, pT4N2MO stage lll, i was researching and read day and night looking for the information regarding my diagnosis. I am not a doctor but I don’t think you should worry much. Your report shows you have well differentiated tumor (which is very slow growing ), stage II pT3NxM0. You are in stage ll , which is also not bad , and MO indicated no distant metastasis, according to your report. The doctor will tell you more but that’s from my experience and little research that i have doing. Just relax, you will be fine!
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2 ReactionsI completely understand your frustration over the lack of knowledge about these tumors. My husbands local oncologist did not understand basic facts about diagnosis and treatment of them. Fortunately, there is a nearby university hospital takes the time to work with us and determine next best steps; he is scheduled for surgery soon. His is a nonfunctional pancreatic NET.
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3 ReactionsTy so much.
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1 ReactionHello @riffieli
Your concerns are understandable. I have had three surgeries for NETs in the upper digestive tract and from my understanding, an MRI is the best way to view the liver. I have an MRI done every other year to view both pancreatic cysts and the liver. The cysts were originally found on a CT scan, but I was told that the MRI was the best way to picture the liver and pancreas.
It is best not to get overly worried (I know that this is easier said than done). Until you get more clarification from the MRI results, try to relax and do something to get your mind off of the upcoming tests.
I look forward to hearing from you again. Will you continue to post as you have questions or concerns?
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