Concerns Regarding PET Scan Findings for a Family Member with Rectal NET
Hello, I'm reaching out as a concerned resident regarding a family member's health situation. In November, they were diagnosed with a grade 1 rectal neuroendocrine tumor (NET), which was surgically removed during a standard colonoscopy. The tumor measured 10mm and the Ki-67 index was less than 3%. Six months later, a follow-up flexible sigmoidoscopy with biopsy indicated that there was no remaining carcinoid tissue. A Dotatate PET scan combined with CT imaging was performed to ensure thoroughness, and it revealed no residual activity in the rectal area, nor any signs of adenopathy or hypermetabolic activity in the lymph nodes, liver, or any other regions. However, there was one notable hypermetabolic lytic lesion identified in the C5 vertebral body with a standardized uptake value (SUV) of 5.4. This discovery has left me quite puzzled; it seems improbable for a neuroendocrine tumor to progress directly to the spine while bypassing the liver and lymph nodes, especially in the absence of any residual signs at the original tumor site. I have come across literature suggesting a poor prognosis once a NET has reached the spine, and I find myself sifting through various case reports to find clarity. Unfortunately, my specialty does not typically involve PET scans, so I lack extensive knowledge in this area. I would appreciate any insights or thoughts that others might have on this matter. Details of the Patient: Male, 66 years old, weighing 80kg and standing at 5'10". He is a non-smoker with a medical history of well-controlled hypertension, type 2 diabetes mellitus, and benign prostatic hyperplasia. Current medications include an ACE inhibitor and metformin. The issue has persisted since the diagnosis in November 2024.
Answers (1)
7/2/2025, 10:50:39 PM
OpenHealth AI
It’s understandable to feel concerned about the PET scan findings regarding your family member's health. The hypermetabolic lytic lesion in the C5 vertebral body, especially after treatment for a rectal NET, raises valid questions. While I cannot provide specific medical advice, I can share some insights that may help you understand the situation better and suggest steps forward.
Key Points:
- PET Scan Findings: A hypermetabolic lytic lesion can indicate various conditions, including benign processes, infections, or malignancies.
- Uncommon Progression: It is indeed rarer for neuroendocrine tumors to metastasize directly to bone without affecting other areas first.
- Next Steps: Taking appropriate consultations is crucial for better clarity and planning.
Explanation:
- Interpreting the Lesion: The SUV (standardized uptake value) of 5.4 for the lesion in the C5 vertebra indicates increased metabolic activity, which warrants further investigation. Not all hypermetabolic lesions are cancerous, as they can also arise from infections, healing processes, or benign tumors.
- NET Behavior: Neuroendocrine tumors can have varied patterns of spread. They often metastasize to the liver and lymph nodes first, but some cases do present atypically.
Recommended Steps:
- Oncology Consultation: Schedule an appointment with an oncologist or a specialist in neuroendocrine tumors. Discuss the PET scan findings in detail.
- Further Imaging: Depending on the oncologist's recommendation, more imaging studies (like an MRI of the spine) may be necessary to evaluate the nature of the C5 lesion.
- Monitor Symptoms: Keep track of any new symptoms, such as pain or neurological changes, that may arise related to the spine.
It's commendable that you're seeking information and support for your family member during this challenging time. Gathering comprehensive insights will help in making informed decisions regarding their care. If you have further questions or need specific resources, feel free to ask.
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