Carcinoid tumor of the appendix.PET scan results

Posted by riffieli @riffieli, Dec 21, 2022

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.

Interested in more discussions like this? Go to the Neuroendocrine Tumors (NETs) Support Group.

First 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?

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@rice099

First 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?

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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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