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Vol.46 No.4 contents

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- Case Report -

Preoperative Detection of an ACTH-producing Small Bronchial Carcinoid with ¹¹¹In-pentetoreotide (Somatostatin Analog) Scintigraphy

Teruhisa Takuwa¹, Seiki Hasegawa¹, Fumihiro Tanaka¹, Hiromi Wada^2
1Department of General Thoracic Surgery, Hyogo College of Medicine, Japan, ²Department of General Thoracic Surgery, Kyoto University, Japan

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Background. It is difficult to localize ectopic ACTH-secreting tumors. This is particulary true in small tumors. We report a case where somatostatin receptor scintigraphy was useful in the localization of ACTH-producing tumor. Case. A 34-year-old man was found to have Cushing's syndrome with ectopic ACTH production. Although CT, MRI and FDG-PET failed to reveal the ectopic source of ACTH, ¹¹¹In-pentetreotide scintigraphy demonstrated marked accumulation in the right middle lobe. We therefore performed a thin-sliced chest CT, and an intrabronchial tumor was found in the right middle branch (B⁴a). Preoperative diagnosis of ACTH-producing bronchial carcinoid was made by bronchoscopic biopsy. Plasma ACTH and serum cortisol levels decreased immediately after resection of the right middle lobe. ACTH production by tumor cells was confirmed by immunohistochemistry. Conclusion. This case indicates that ¹¹¹In-pentetreotide scintigraphy may be useful to identify and localize ectopic ACTH-producing tumors.
key words: Ectopic ACTH-secreting tumor, Bronchial carcinoid, Cushing's syndrome, ¹¹¹In-pentetreotide scintigraphy

Received: November 4, 2005
Accepted: June 5, 2006

JJLC 46 (4): 375-378, 2006