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LETTER TO THE EDITOR
Year : 2013  |  Volume : 17  |  Issue : 4  |  Page : 765-767

Positive 68 Ga-DOTANOC PET/CT with negative 131 I- metaiodobenzylguanidine scan in a case of Glomus Jugulare


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication20-Jun-2013

Correspondence Address:
Nishikant A Damle
Senior Research Associate, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.113781

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How to cite this article:
Damle NA, Kumar R, Tripathi M, Bal C. Positive 68 Ga-DOTANOC PET/CT with negative 131 I- metaiodobenzylguanidine scan in a case of Glomus Jugulare. Indian J Endocr Metab 2013;17:765-7

How to cite this URL:
Damle NA, Kumar R, Tripathi M, Bal C. Positive 68 Ga-DOTANOC PET/CT with negative 131 I- metaiodobenzylguanidine scan in a case of Glomus Jugulare. Indian J Endocr Metab [serial online] 2013 [cited 2019 Nov 12];17:765-7. Available from: http://www.ijem.in/text.asp?2013/17/4/765/113781

Sir,

Paragangliomas of the head and neck are extremely rare tumors (approximately 1 in 30,000 head and neck tumors). [1] Since these tumors are difficult to access and very vascular, diagnostic biopsy is not feasible due to the risk of significant bleeding and neurovascular damage. Diagnosis of Glomus jugulare or Glomus vagale is therefore difficult. Patients usually present late and with otologic/neurologic symptoms. CT and MRI provide highly suggestive information, including hypervascularity or bony erosions. Howeve&r, in some instances, these modalities may not differentiate paragangliomas from meningioma, schwannoma or metastasis. Arteriography has a limited role and also carries the risk of neurologic complications. Also, head and neck paragangliomas may be biochemically silent, which is another reason why a non-invasive diagnostic method becomes important.

A fifty two year old lady, presented with chief complaints of impairment of hearing and tinnitus in the left ear since one year with left temporal headache. She also had IX, X, XI cranial nerve palsy on the left side. There was no history of hypertension. Otoscopy showed a pulsatile reddish mass behind intact ear drum involving inferior part of pars-tensa. CT scan bone window images in the axial plane showed a soft tissue mass lesion causing irregular bone destruction seen in the location of left jugular foramen. Erosions were also seen in the adjoining left occipital bone. This lesion showed intense uptake of 68 Ga-DOTANOC but no detectable abnormality on 131 I-MIBG scan [Figure 1].
Figure 1: 131I-MIBG whole body scan anterior and posterior views showing no defi nite abnormality (left) with CT scan bone window images in the axial plane showed a soft tissue mass lesion causing irregular bone destruction seen in the location of left jugular foramen. Erosions were also seen in the adjoining left side occipital bone. This lesion showed intense uptake of 68Ga-DOTANOC on PET/CT

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Somatostatin receptor scintigraphy (SRS), is a noninvasive nuclear medicine imaging method based on somatostatin receptor expression in paragangliomas. [2],[3] Thus, SRS excludes schwannomas and non-neuroendocrine tumoral metastasis, from paragangliomas. SRS cannot differentiate paraganglioma from meningioma, as demonstrated by earlier studies. [4] . However, this is also a limitation of 123 I/ 131 I metaiodobenzylguanidine ( 123 I-MIBG) scintigraphy because 123 I-MIBG uptake is variable in paragangliomas. [5]

The distinction between meningioma and paraganglioma can then be made by arteriography. SRS could limit the use of arteriography to patients who intend to undergo surgery and require an embolization procedure for these hypervascularized tumors.

Octreotide and MIBG have been shown to exert a complementary role in the detection and treatment of neuroendocrine tumors in occasional patients but SRS is more sensitive for extra-adrenal tumors. [6] Our case reinforces this hypothesis. Hence, in a case where there is strong clinical suspicion but negative MIBG scan, a 68 Gallium-DOTANOC scan may help to establish the diagnosis of Glomus Jugulare.

 
   References Top

1.Myssiorek D. Head and neck paragangliomas: An overview. Otolaryngol Clin North Am 2001;34:829-36.  Back to cited text no. 1
    
2.Lamberts SW, Krenning EP, Reubi JC. The role of somatostatin and its analogsin the diagnosis and treatment of tumors. Endocr Rev 1991;12:450-82.  Back to cited text no. 2
    
3.Kwekkeboom DJ, van Urk H, Pauw BK, Lamberts SW, Kooij PP, Hoogma RP, et al. Octreotide scintigraphy for the detection of paragangliomas. J Nucl Med 1993;34:873-8.  Back to cited text no. 3
    
4.Duet M, Sauvaget E, Petelle B, Rizzo N, Guichard JP, Wassef M, et al. Clinical impact of somatostatin receptor scintigraphy in the management of paragangliomas of the head and neck. J Nucl Med 2003;44:1767-74.  Back to cited text no. 4
    
5.Muros MA, Llamas-Elvira JM, Rodriguez A, Ramírez A, Gómez M, Arráez MA, et al. 111 In-Pentetreotide scintigraphyis superior to 123 I-MIBG scintigraphy in the diagnosis and location of chemodectoma. Nucl Med Commun 1998;19:735-42.  Back to cited text no. 5
    
6.Kaltsas G, Korbonits M, Heintz E, Mukherjee JJ, Jenkins PJ, Chew SL, et al. Comparison of somatostatin analog and meta-iodobenzylguanidine radionuclides in the diagnosis and localization of advanced neuroendocrine tumors. J Clin Endocrinol Metab 2001;86:895-902.  Back to cited text no. 6
    


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[Pubmed] | [DOI]



 

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