INTERESTING IMAGE
Sister Mary Joseph Nodules on 99mTc HYNIC-TOC Scintigraphy in Patients With Neuroendocrine Tumors Hongli Jing, MD, Yingqiang Zhang, MD, and Fang Li, MD Abstract: A Sister Mary Joseph nodule represents an umbilical metastasis, which is more commonly caused by a primary malignancy in gastrointestinal tract or from reproductive system. We report Sister Mary Joseph nodules caused by neuroendocrine tumor and revealed on 99mTc HYNIC-TOC scintigraphy. (Clin Nucl Med 2015;40: 166Y168)
Received for publication June 11, 2014; revision accepted July 3, 2014. From the Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China Conflicts of interest and sources of funding: none declared. Reprints: Fang Li, MD, Department of Nuclear Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing St, Dongcheng District, Beijing, 100730, People’s Republic of China. E-mail: [email protected]. Copyright * 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4002Y0166
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REFERENCES 1. Jing H, Li F, Zhuang H, et al. Effective detection of the tumors causing osteomalacia using [Tc-99m]-HYNIC-octreotide (99mTc-HYNIC-TOC) whole body scan. Eur J Radiol. 2013;82:2028Y2034. 2. Chen L, Li F, Zhuang H, et al. 99mTc-HYNIC-TOC scintigraphy is superior to 131I-MIBG imaging in the evaluation of extraadrenal pheochromocytoma. J Nucl Med. 2009;50:397Y400. 3. Jin X, Jing H, Li F, et al. Osteomalacia-inducing renal clear cell carcinoma uncovered by 99mTc-hydrazinonicotinyl-Tyr3-octreotide (99mTc-HYNIC-TOC) scintigraphy. Clin Nucl Med. 2013;38:922Y924. 4. Jing H, Li F, Zhong D, et al. 99mTc-HYNIC-TOC (99mTc-hydrazinonicotinylTyr3-octreotide) scintigraphy identifying two separate causative tumors in a patient with tumor-induced osteomalacia (TIO). Clin Nucl Med. 2013;38: 664Y667. 5. Chen L, Li F, Zhuang H, et al. Cardiac pheochromocytomas detected by Tc-99m-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) scintigraphy. Clin Nucl Med. 2007;32:182Y185. 6. Niu N, Mao X, Jing H, et al. Parathyroid hyperplasia shown on (99m)TcHYNIC-TOC scan. Clin Nucl Med. 2013;38:294Y296. 7. Sun H, Jiang XF, Wang S, et al. (99m)Tc-HYNIC-TOC scintigraphy in evaluation of active Graves’ ophthalmopathy (GO). Endocrine. 2007;31:305Y310. 8. Datta S, Sengupta SG, Bhattacherjee S, et al. Umbilical nodule, an uncommon presentation of gastric malignancy. J Assoc Physicians India. 2012;60:51Y53. 9. Nolan C, Semer D. Endometrial cancer diagnosed by Sister Mary Joseph nodule biopsy: Case report. Gynecol Oncol Case Rep. 2012;2:110Y111. 10. Hori T, Okada N, Nakauchi M, et al. Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery. World J Gastrointest Surg. 2013;5:272Y277. 11. Scudeler D, Wakely PE Jr. Fine needle aspiration biopsy of gastrointestinal stromal tumor presenting as an umbilical mass (Sister Mary Joseph’s nodule). Ann Diagn Pathol. 2006;10:100Y103. 12. Pua U, Quek L. Endometrial cancer presenting as a paraumbilical hernia containing a Sister Mary Joseph nodule. Int J Gynaecol Obstet. 2009;107:156. 13. Whang TB, Wang L, Peng DH. Gastric carcinoma of the umbilicus: case report of Sister Mary Joseph nodule. Cutis. 2010;85:90Y92. 14. Khan K, Bagchi D. Squamous cell carcinoma arising in a testicular teratoma and presenting as Sister Mary Joseph nodule. J Surg Tech Case Rep. 2011;3: 99Y101. 15. Kruczek K, Nabhan C. Sister Mary Joseph nodule from prostate cancer. J Am Osteopath Assoc. 2012;112:462. 16. Hopton BP, Wyatt JI, Ambrose NS. A case of Sister Mary Joseph nodule associated with primary gastric lymphoma. Ann R Coll Surg Engl. 2005;87: W6YW7. 17. Deb P, Rai RS, Rai R, et al. Sister Mary Joseph nodule as the presenting sign of disseminated prostate carcinoma. J Cancer Res Ther. 2009;5:127Y129. 18. Singh H, Sharma P, Reddy RM, et al. Sister Mary Joseph nodule in endometrial carcinoma: detection with FDG PET/CT. Clin Nucl Med. 2013;38:e263Ye264. 19. Weiland FL, Carretta RF. 67Ga-citrate accumulation in a Sister Mary Joseph nodule. Clin Nucl Med. 1978;3:335Y336. 20. Evans JW, Dutton J, Ng C, et al. Calcified ‘‘Sister Mary Joseph’’ umbilical metastasis from ovarian cystadenocarcinoma seen on an MDP bone scintigram. Clin Nucl Med. 2002;27:134Y135. 21. Metivier D Jr, Bonardel G, Rouquie D, et al. 18F-FDG PET/CT imaging of Sister Mary Joseph’s nodule. Clin Nucl Med. 2012;37:486Y488.
Clinical Nuclear Medicine
& Volume 40, Number 2, February 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine
& Volume 40, Number 2, February 2015
Sister Mary Joseph Nodules on HYNIC-TOC
FIGURE 1. HYNIC-TOC scintigraphy, which uses 99mTc-labeled octreotide, is commonly utilized in China1Y7 as a substitute of 111 In-labeled octreoscan because 111In is unavailable in China. A 47-year-old woman had history of well-differentiated neuroendocrine carcinoma in the tail of the pancreas diagnosed 4 years ago. Following the resection and chemotherapy, the patient was doing well until recently when she began to suffer abdominal pain for unknown reason. Possible recurrent malignancy was considered, and HYNIC-TOC scintigraphy was performed. The whole-body images (A) revealed several large regions of elevated activity in the liver (large arrows). In addition, a small focal activity (small arrow) was noted in the region of umbilicus. On the following SPECT/CT images (B: SPECT; C: CT; and D: fusion), this activity was located in a soft tissue nodule (small arrows) in the umbilicus. A CT-guided biopsy of umbilical soft tissue nodule was subsequently performed. The pathological examination from the biopsy specimen confirmed recurrent neuroendocrine carcinoma.
* 2014 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
167
Jing et al
Clinical Nuclear Medicine
& Volume 40, Number 2, February 2015
FIGURE 2. A 43-year-old man with graduated weight loss in the past year had worsening abdominal pain for about 3 months and diarrhea for 3 weeks. An abdominal contrast CT examination from an outside institution showed mass in the tail of pancreas and suggested pancreatic malignancy. The patient came to our hospital for second opinion. HYNIC-TOC whole scintigraphy was performed, which revealed large intense activity (large arrow) in the region of the pancreatic tail, which was consistent with findings from outside CT examination. In addition, a small focus of activity in the midabdomen was noted on anterior view image (small arrow). Subsequent SPECT/CT images demonstrated that the activity was located in the umbilicus. A diagnosis of primary neuroendocrine tumor with umbilical metastasis was made after pathological examination of the pancreatic lesion. Sister Mary Joseph nodules are rare metastatic lesions in the umbilical region, which are frequently from primary malignancies in the gastrointestinal tract and genital systems.8Y18 Depending on the primary tumors, the Sister Mary Joseph nodule can lead to increased activity of different tracers used in nuclear medicine, such as gallium 67Ga,19 99mTc MDP,20 or 18F FDG.18,21 Nevertheless, Sister Mary Joseph nodules from neuroendocrine tumors are rare encounters.
168
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* 2014 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Sister Mary Joseph Nodules on 99mTc HYNIC-TOC Scintigraphy in Patients With Neuroendocrine Tumors Hongli Jing, MD, Yingqiang Zhang, MD, and Fang Li, MD Abstract: A Sister Mary Joseph nodule represents an umbilical metastasis, which is more commonly caused by a primary malignancy in gastrointestinal tract or from reproductive system. We report Sister Mary Joseph nodules caused by neuroendocrine tumor and revealed on 99mTc HYNIC-TOC scintigraphy. (Clin Nucl Med 2015;40: 166Y168)
Received for publication June 11, 2014; revision accepted July 3, 2014. From the Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China Conflicts of interest and sources of funding: none declared. Reprints: Fang Li, MD, Department of Nuclear Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing St, Dongcheng District, Beijing, 100730, People’s Republic of China. E-mail: [email protected]. Copyright * 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4002Y0166
166
www.nuclearmed.com
REFERENCES 1. Jing H, Li F, Zhuang H, et al. Effective detection of the tumors causing osteomalacia using [Tc-99m]-HYNIC-octreotide (99mTc-HYNIC-TOC) whole body scan. Eur J Radiol. 2013;82:2028Y2034. 2. Chen L, Li F, Zhuang H, et al. 99mTc-HYNIC-TOC scintigraphy is superior to 131I-MIBG imaging in the evaluation of extraadrenal pheochromocytoma. J Nucl Med. 2009;50:397Y400. 3. Jin X, Jing H, Li F, et al. Osteomalacia-inducing renal clear cell carcinoma uncovered by 99mTc-hydrazinonicotinyl-Tyr3-octreotide (99mTc-HYNIC-TOC) scintigraphy. Clin Nucl Med. 2013;38:922Y924. 4. Jing H, Li F, Zhong D, et al. 99mTc-HYNIC-TOC (99mTc-hydrazinonicotinylTyr3-octreotide) scintigraphy identifying two separate causative tumors in a patient with tumor-induced osteomalacia (TIO). Clin Nucl Med. 2013;38: 664Y667. 5. Chen L, Li F, Zhuang H, et al. Cardiac pheochromocytomas detected by Tc-99m-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) scintigraphy. Clin Nucl Med. 2007;32:182Y185. 6. Niu N, Mao X, Jing H, et al. Parathyroid hyperplasia shown on (99m)TcHYNIC-TOC scan. Clin Nucl Med. 2013;38:294Y296. 7. Sun H, Jiang XF, Wang S, et al. (99m)Tc-HYNIC-TOC scintigraphy in evaluation of active Graves’ ophthalmopathy (GO). Endocrine. 2007;31:305Y310. 8. Datta S, Sengupta SG, Bhattacherjee S, et al. Umbilical nodule, an uncommon presentation of gastric malignancy. J Assoc Physicians India. 2012;60:51Y53. 9. Nolan C, Semer D. Endometrial cancer diagnosed by Sister Mary Joseph nodule biopsy: Case report. Gynecol Oncol Case Rep. 2012;2:110Y111. 10. Hori T, Okada N, Nakauchi M, et al. Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery. World J Gastrointest Surg. 2013;5:272Y277. 11. Scudeler D, Wakely PE Jr. Fine needle aspiration biopsy of gastrointestinal stromal tumor presenting as an umbilical mass (Sister Mary Joseph’s nodule). Ann Diagn Pathol. 2006;10:100Y103. 12. Pua U, Quek L. Endometrial cancer presenting as a paraumbilical hernia containing a Sister Mary Joseph nodule. Int J Gynaecol Obstet. 2009;107:156. 13. Whang TB, Wang L, Peng DH. Gastric carcinoma of the umbilicus: case report of Sister Mary Joseph nodule. Cutis. 2010;85:90Y92. 14. Khan K, Bagchi D. Squamous cell carcinoma arising in a testicular teratoma and presenting as Sister Mary Joseph nodule. J Surg Tech Case Rep. 2011;3: 99Y101. 15. Kruczek K, Nabhan C. Sister Mary Joseph nodule from prostate cancer. J Am Osteopath Assoc. 2012;112:462. 16. Hopton BP, Wyatt JI, Ambrose NS. A case of Sister Mary Joseph nodule associated with primary gastric lymphoma. Ann R Coll Surg Engl. 2005;87: W6YW7. 17. Deb P, Rai RS, Rai R, et al. Sister Mary Joseph nodule as the presenting sign of disseminated prostate carcinoma. J Cancer Res Ther. 2009;5:127Y129. 18. Singh H, Sharma P, Reddy RM, et al. Sister Mary Joseph nodule in endometrial carcinoma: detection with FDG PET/CT. Clin Nucl Med. 2013;38:e263Ye264. 19. Weiland FL, Carretta RF. 67Ga-citrate accumulation in a Sister Mary Joseph nodule. Clin Nucl Med. 1978;3:335Y336. 20. Evans JW, Dutton J, Ng C, et al. Calcified ‘‘Sister Mary Joseph’’ umbilical metastasis from ovarian cystadenocarcinoma seen on an MDP bone scintigram. Clin Nucl Med. 2002;27:134Y135. 21. Metivier D Jr, Bonardel G, Rouquie D, et al. 18F-FDG PET/CT imaging of Sister Mary Joseph’s nodule. Clin Nucl Med. 2012;37:486Y488.
Clinical Nuclear Medicine
& Volume 40, Number 2, February 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine
& Volume 40, Number 2, February 2015
Sister Mary Joseph Nodules on HYNIC-TOC
FIGURE 1. HYNIC-TOC scintigraphy, which uses 99mTc-labeled octreotide, is commonly utilized in China1Y7 as a substitute of 111 In-labeled octreoscan because 111In is unavailable in China. A 47-year-old woman had history of well-differentiated neuroendocrine carcinoma in the tail of the pancreas diagnosed 4 years ago. Following the resection and chemotherapy, the patient was doing well until recently when she began to suffer abdominal pain for unknown reason. Possible recurrent malignancy was considered, and HYNIC-TOC scintigraphy was performed. The whole-body images (A) revealed several large regions of elevated activity in the liver (large arrows). In addition, a small focal activity (small arrow) was noted in the region of umbilicus. On the following SPECT/CT images (B: SPECT; C: CT; and D: fusion), this activity was located in a soft tissue nodule (small arrows) in the umbilicus. A CT-guided biopsy of umbilical soft tissue nodule was subsequently performed. The pathological examination from the biopsy specimen confirmed recurrent neuroendocrine carcinoma.
* 2014 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
167
Jing et al
Clinical Nuclear Medicine
& Volume 40, Number 2, February 2015
FIGURE 2. A 43-year-old man with graduated weight loss in the past year had worsening abdominal pain for about 3 months and diarrhea for 3 weeks. An abdominal contrast CT examination from an outside institution showed mass in the tail of pancreas and suggested pancreatic malignancy. The patient came to our hospital for second opinion. HYNIC-TOC whole scintigraphy was performed, which revealed large intense activity (large arrow) in the region of the pancreatic tail, which was consistent with findings from outside CT examination. In addition, a small focus of activity in the midabdomen was noted on anterior view image (small arrow). Subsequent SPECT/CT images demonstrated that the activity was located in the umbilicus. A diagnosis of primary neuroendocrine tumor with umbilical metastasis was made after pathological examination of the pancreatic lesion. Sister Mary Joseph nodules are rare metastatic lesions in the umbilical region, which are frequently from primary malignancies in the gastrointestinal tract and genital systems.8Y18 Depending on the primary tumors, the Sister Mary Joseph nodule can lead to increased activity of different tracers used in nuclear medicine, such as gallium 67Ga,19 99mTc MDP,20 or 18F FDG.18,21 Nevertheless, Sister Mary Joseph nodules from neuroendocrine tumors are rare encounters.
168
www.nuclearmed.com
* 2014 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
