Treatment of Glucagonoma-Related Necrolytic Migratory Erythema With Peptide Receptor Radionuclide Therapy

Abstract

Glucagonomas are rare types of pancreatic neuroendocrine tumors. They may present with a clinical entity called glucagonoma syndrome, which includes necrolytic migratory erythema as a skin component. Here we present a 26-year-old woman experiencing ongoing skin lesions, excessive weight loss, and nausea. She was diagnosed with metastatic glucagonoma. Her 68Ga-DOTATATE PET/CT showed increased uptake at the primary pancreatic lesion and hepatic metastases. She received 2 cycles of peptide receptor radionuclide therapy and had a partial response with a near-complete regression of her skin lesions.

“Stocking Pattern Metabolic Captivity” of Legs on 18F-FDG PET-CT in Necrotizing Fasciitis: Potential Complimentary Role in Differential Diagnosis and Assessment of Disease Extent in a Life-Threatening Condition

“…The report stated FDG-PET/CT may be helpful in the diagnosis of eosinophilic fasciitis as it could clearly illustrate anatomical involvement of the disease. 17 Another PET tracer like 68 Ga-DOTATATE PET/CT can have diagnostic role delineating suspected glucagonoma 18 or active inflammatory processes where macrophages and leukocyte do express SSTR2 receptors. 19…”

“…The report stated FDG-PET/CT may be helpful in the diagnosis of eosinophilic fasciitis as it could clearly illustrate anatomical involvement of the disease. 17 Another PET tracer like 68 Ga-DOTATATE PET/CT can have diagnostic role delineating suspected glucagonoma 18 or active inflammatory processes where macrophages and leukocyte do express SSTR2 receptors. 19 With regard to considering the optimal management, Khalid et al reported necrotizing soft tissue infections being associated with considerable morbidity and mortality, and delayed recognition and treatment can have severe implications.…”

“…1 and 2) was undertaken 60 minutes after intravenous injection of 6.5 mCi of 18 F-FDG, using a whole-body fullring dedicated three-dimensional PET-CT scanner (Gemini TF; 250 mAs, 120 kVp, noncontrast CT scan with 2 mm slice thickness). 18 F-FDG-PET/CT revealed circumferential hypermetabolism along the fasciae of bilateral lower extremities while sparing muscles and subcutaneous fat extending from below knee level till dorsum of feet (standardized uptake value [SUV]max 4.75). Linear increased FDG uptake was noted in psoas muscles bilaterally (right > left) (SUVmax 6.15) (►Figs.…”

“…A 36-year-old male presented with bilaterally symmetrical cutaneous lesions involving lower limbs that rapidly progressed to ulcerative lesions and pancytopenia. In view of suspicion of paraneoplastic manifestation, the patient underwent 18 F-FDG-PET/CT to rule out any underlying malignancy. The FDG-PET/CT findings confirmed hypermetabolism circumferentially along the fasciae of bilateral lower extremities while sparing muscles and subcutaneous fat from below the knee till toe with diffused hypermetabolic marrow, and no evidence of focal disease suggesting malignancy.…”

Pancreatic neuroendocrine neoplasms — update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne trzustki — uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)]

“…Most polish centres treating patients with NEN have had positive experience in this area. Recently, there was a report on a case of a 26-year-old woman with disseminated glucagonoma after the administration of two cycles of PRRT, who achieved a partial response to treatment with almost complete regression of skin lesions in the form of necrotic migratory erythema [188]. According to Guidelines our previous guidelines, the neoadjuvant treatment with PRRT in selected primary unresectable, secreting and non-secreting PanNET cases should be maintained as well as the possible use of PRRT as first-line treatment in malignant insulinomas to control symptoms of the disease.…”