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Abstract

I thank Whitaker for his interest in our recently published article.1Filosso P.L. Actis Dato G.M. Ruffini E. Bretti S. Ozzello F. Mancuso M. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): report of a successful case and review of the literature.J Thorac Cardiovasc Surg. 2004; 127: 1215-1219Abstract Full Text Full Text PDF PubMed Scopus (32) Google ScholarThe message of this article was the feasibility and the efficacy of a multidisciplinary (chemoradiotherapy, surgery, and biologic therapy) treatment for a giant and biologically aggressive thymic neuroendocrine tumor. The patient underwent preoperative octreotide scintigraphy with positive results, the in vivo demonstration of the somatostatin receptors presence in the neoplastic tissue. It is widely known that neuroendocrine tumors can have negative results of octreotide scintigraphy; in my own experience, I have observed several bronchial carcinoids (both typical and atypical) with negative results of octreotide scintigraphy and without somatostatin receptors in surgical specimens. In some of these cases, positron emission tomographic (PET) scan results were positive. Probably these cases represent a more aggressive variant of neuroendocrine neoplasm, but further reports are needed to confirm this hypothesis. I agree with Whitaker's suggestion to use PET scan when results of octreotide scintigraphy are negative in the preoperative patient assessment. One must consider, however, that PET scan is not widely available in my country, and the cost of this procedure is still high. Had the patient I described had negative results of octreotide scintigraphy, I definitely would have considered PET or metaiodobenzylguanidine scanning. Thymic neuroendocrine carcinoma (carcinoid): What if octreotide scanning is negative?The Journal of Thoracic and Cardiovascular SurgeryVol. 128Issue 5PreviewI was interested to read Filosso and colleagues' recent description1 of a case of thymic neuroendocrine carcinoma (carcinoid) successfully treated with neoadjuvant radiotherapy and chemotherapy and the somatostatin (sst2) analog octreotide. Filosso and colleagues1 stated, “Neuroendocrine tumors, including thymic tumors, express sst2 at immunohistochemistry.”Other than octreotide scanning and computed tomography or magnetic resonance imaging (which were clearly useful in their case), they did not discuss other methods of localizing these tumors. Full-Text PDF