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LETTER TO EDITOR
Year : 2016  |  Volume : 31  |  Issue : 2  |  Page : 161-162  

111 In-pentetreotide uptake in accessory spleen: A potential pitfall in somatostatin receptor scintigraphy


1 Department of Nuclear Medicine, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
2 Department of Radiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey

Date of Web Publication9-Mar-2016

Correspondence Address:
Tarik Elri
Department of Nuclear Medicine, School of Medicine, Bulent Ecevit University, Esenkoy/Kozlu, 67600 Zonguldak
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.178341

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How to cite this article:
Salihoglu YS, Elri T, Erdemir RU, Yazgan O. 111 In-pentetreotide uptake in accessory spleen: A potential pitfall in somatostatin receptor scintigraphy. Indian J Nucl Med 2016;31:161-2

How to cite this URL:
Salihoglu YS, Elri T, Erdemir RU, Yazgan O. 111 In-pentetreotide uptake in accessory spleen: A potential pitfall in somatostatin receptor scintigraphy. Indian J Nucl Med [serial online] 2016 [cited 2019 Sep 18];31:161-2. Available from: http://www.ijnm.in/text.asp?2016/31/2/161/178341

Sir,

Accessory spleen is a potential pitfall in radiologic and radionuclide evaluation of oncologic patients which may cause misdiagnosis as left adrenal tumor or metastasis. It is a benign and relatively common splenic anomaly so that seen 16% of the normal population with contrast enhanced abdominal computerized tomography (CT). They mostly localized in splenic hilum, but may be seen in any locations in the abdomen. [1] Accessory spleen may show physiological increased 111 In-pentetreotide uptake and mimic malignancy in somatostatin receptor scintigraphy (SRS) as with other imaging techniques. Even though some findings described such as well-defined, homogeneously enhancing, uniform round soft tissue densities smaller than 2 cm that might be meaningful, it is not always possible to make a definitive diagnosis with CT. [2],[3]

Herein, we present a 49-year-old female patient with cushing disease underwent transsphenoidal adenomectomy, which was requested SRS with 111 In-pentetreotide for suspected ectopic adrenocorticotropic hormone (ACTH) secreting tumor, due to high serum cortisol and ACTH levels during regular postoperative follow-up. SRS was performed after intravenous injection with 6 mCi 111 In-pentetreotide (octreoscan) using a dual-headed gamma camera (Symbia S, Siemens, USA) with medium-energy parallel hole collimators. Planar whole body images with thorax and abdomen single-photon emission CT (SPECT) images were obtained at 4 and 24 h. In addition to physiological uptake in liver, spleen, and kidneys, two foci of increased tracer uptakes were detected adjacent to spleen and in the nephrosplenic space [Figure 1]. In the retrospective assessment of concurrent abdomen CT, well demarcated round lesions which were isointense with spleen suggesting accessory spleen were detected. These lesions were matched with the focal increased tracer uptakes on SRS. A selective spleen scintigraphy using 99mTc-labeled heat denatured erythrocytes spleen scintigraphy (SSS) was also performed for correlation. Modified in vitro labeling method was used for SSS. Thirty minutes after the injection of 10.0 mCi (370 MBq) heat-denatured, 99m Tc-labeled autologous red blood cells, an abdomen SPECT, and planar images were acquired. It showed two foci of increased uptake due to accessory spleen which was matched with the lesions on SRS.
Figure 1: 111In-pentetreotide scintigraphy single-photon emission computed tomography showed two foci of increased uptakes adjacent to spleen (black arrow) and in the nephrosplenic space (white arrow) in (a) (raw image), (b) (coronal slice), and (c) (axial slice). Selective spleen scintigraphy using 99mTc-labeled heat denatured erythrocytes showed two foci of increased uptake which were matched with the lesions on somatostatin receptor scintigraphy and compatible with accessory spleen in (d) (raw image), (e) (coronal slice), and (f) (axial slice)

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In the literature, majority of the reported cases related with accessory spleen were based on false positive evaluation, especially in splenectomized patients. [3],[4] However, Sels et al. presented that lesions which assessed in favor of accessory spleen on CT and magnetic resonance imaging were shown to be neuroendocrine tumor with tissue biopsy later. [5] In our case, instead of performing histopathological analysis, we verified the increased 111 In-pentetreotide uptakes with SSS. Splenic scan with 99m Tc-labelled denatured red blood cells is a cost-effective and noninvasive radionuclide imaging method used in detecting ectopic splenic tissues such as accessory spleen and splenosis with high sensitivity and specificity. [6],[7] Detection of the intrapancreatic accessory spleen has been reported using 68 Ga-DOTANOC positron emission tomography/CT. [8] In conclusion, one should be aware that it is important to make a definitive diagnosis in the suspicion of accessory spleen in any imaging modalities and suspicious uptakes around the spleen in SRS for an accurate clinical management in patients with malignancies. Since CT is not enough for all cases and histopathological verification of each lesion is not feasible, we recommend SSS as a final diagnostic step in such cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Yildiz AE, Ariyurek MO, Karcaaltincaba M. Splenic anomalies of shape, size, and location: Pictorial essay. Scientific World Journal 2013;2013:321810.  Back to cited text no. 1
    
2.
Mortelé KJ, Mortelé B, Silverman SG. CT features of the accessory spleen. AJR Am J Roentgenol 2004;183:1653-7.  Back to cited text no. 2
    
3.
Lebtahi R, Cadiot G, Marmuse JP, Vissuzaine C, Petegnief Y, Courillon-Mallet A, et al. False-positive somatostatin receptor scintigraphy due to an accessory spleen. J Nucl Med 1997;38:1979-81.  Back to cited text no. 3
    
4.
Martínez-Rodríguez I, Allende RH, Banzo I, Quirce R, Jiménez-Bonilla J, Sainz-Esteban A, et al. Tc-99m red blood cell uptake in positive somatostatin receptor scintigraphy by two accessory spleens. Clin Nucl Med 2006;31:340-1.  Back to cited text no. 4
    
5.
Sels JP, Wouters RM, Lamers R, Wolffenbuttel BH. Pitfall of the accessory spleen. Neth J Med 2000;56:153-8.  Back to cited text no. 5
    
6.
Ekmekçi S, Diz-Küçükkaya R, Türkmen C, Adalet I. Selective spleen scintigraphy in the evaluation of accessory spleen/splenosis in splenectomized/nonsplenectomized patients and the contribution of SPECT imaging. Mol Imaging Radionucl Ther 2015;24:1-7.  Back to cited text no. 6
    
7.
Barber TW, Dixon A, Smith M, Yap KS, Kalff V. Ga-68 octreotate PET/CT and Tc-99m heat-denatured red blood cell SPECT/CT imaging of an intrapancreatic accessory spleen. J Med Imaging Radiat Oncol 2015; doi: 10.1111/1754-9485.12319. [Epub ahead of print].  Back to cited text no. 7
    
8.
Collarino A, del Ciello A, Perotti G, Rufini V. Intrapancreatic accessory spleen detected by 68Ga DOTANOC PET/CT and 99mTc-colloid SPECT/CT scintigraphy. Clin Nucl Med 2015;40:415-8.  Back to cited text no. 8
    


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