Positive octreotide scan in a case of hepatocellular carcinoma

Abstract

The prognosis of patients with hepatocellular carcinoma (HCC) is poor. Blocking somatostatin receptors using octreotide may serve as a possible treatment of inoperable HCC. Somatostatin receptors on tumor cells were shown in vitro in about 40% of patients with HCC [1]. The remaining 60% should have no reasonable benefit from an octreotide therapy. In vivo imaging using radiolabelled octreotide might help to differentiate between these groups. However, Raderer et al. did not find any positive scans in 15 untreated patients with advanced HCC using 111In-octreotide [2]. Here, we present a case of HCC exhibiting an extraordinary high 111In-octreotide uptake. For somatostatin receptor scintigraphy, images were acquired 4, 24 and 48h after injection of 200MBq 111In-Octreoscan (Amersham Health, Braunschweig, Germany). Whole body scintigraphy showed pathological uptake of the tracer in the left scapula, in the xiphoid, in the 12th thoracic vertebra and in projection onto the left ileosacral joint (left panels). SPECT images of the liver showed a total of four areas with a localised enhancement of radioactivity uptake (right panel). These findings supported the diagnosis of HCC. They did not only visualise its multilocular character in the liver but, furthermore, revealed several metastases in the bones. During the last 2 years, we examined seven other patients with HCC using 111In-Octreoscan. As the tracer uptake did not exceed the octreotide uptake in the surrounding liver tissue, the majority of cases were not visible or even appeared as ‘cold lesions’, confirming previous results [2]. The case presented here demonstrates that in vivo detection of somatostatin receptors by octreotide scintigraphy is possible in some cases of liver lesions and extrahepatic metastases. It remains to be evaluated, if a positive octreotide scan might be a valuable predictor of response to octreotide treatment.