Banzo J, Vidal-Sicat S, Prats E, Galofré G, Razola P, Mañé S, Ubieto M A, Abós M D
Nuclear Medicine Service, University Hospital Lozano Blesa, Zaragoza, Spain.
Clin Nucl Med. 2005 May;30(5):308-11. doi: 10.1097/01.rlu.0000159525.31001.cc.
We report a case of a rectal carcinoid tumor that was treated using endoscopic resection. This case highlights the usefulness of using somatostatin receptor scintigraphy in the postresection endoscopy of the tumor and the intraoperative use of a gamma probe detector for the surgical resection of metastatic adenopathy that had not been detected using computed tomography (CT) scanning.
The patient was studied using CT scanning, somatostatin receptor scintigraphy (SRS), and rectal endoscopic ultrasonography (EUS). A gamma probe detector was scheduled for use during the subsequent surgical intervention.
The SRS demonstrated a pelvic metastatic lymphatic node that had not been detected on CT scanning. Additional EUS did not show regional metastatic lymph nodes. Histopathology following removal of retroperitoneal and presacral lymphatic nodes confirmed the diagnosis of metastatic carcinoid tumor. At follow up at 6 months, SRS and rectoscopy were normal.
Somatostatin receptor scintigraphy is very useful in identifying the presence of lymph node metastases, even with a small rectal carcinoid tumor. This is of considerable importance when scheduling surgery and the CT and EUS are normal. The use of an intraoperative gamma-probe detector assists in the surgical excision of the metastatic lymphatic nodes, especially because they had been detected only using SRS, and when their exact location is uncertain.
我们报告一例采用内镜切除治疗的直肠类癌肿瘤病例。该病例突出了在肿瘤切除术后内镜检查中使用生长抑素受体闪烁显像的作用，以及术中使用γ探测器对计算机断层扫描（CT）未检测到的转移性腺病进行手术切除的作用。
对患者进行了CT扫描、生长抑素受体闪烁显像（SRS）和直肠内镜超声检查（EUS）。计划在随后的手术干预中使用γ探测器。
SRS显示出一个CT扫描未检测到的盆腔转移性淋巴结。额外的EUS未显示区域转移性淋巴结。切除腹膜后和骶前淋巴结后的组织病理学证实为转移性类癌肿瘤。6个月随访时，SRS和直肠镜检查均正常。
生长抑素受体闪烁显像在识别淋巴结转移方面非常有用，即使是小的直肠类癌肿瘤。在安排手术且CT和EUS正常时，这一点相当重要。术中使用γ探测器有助于手术切除转移性淋巴结，特别是因为这些淋巴结仅通过SRS检测到且其确切位置不确定时。
