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Eur J Cardiothorac Surg 2002;21:1126
© 2002 Elsevier Science NL

Letter to the Editor

Ectopic ACTH-producing tumors of the chest and octreotide scintigraphy

Department of Thoracic Surgery, S. Giovanni Battista Hospital, University of Torino, Via Genova 3, 10126 Turin, Italy

Received 5 February 2002; accepted 13 February 2002.

* Corresponding author. Tel.: +39-11-6336635; fax: +39-11-6960170
e-mail: pierluigifilosso{at}tiscalinet.it

We read with interest the paper by Dell'Asta et al. [1].

In 1995 we published an article in which we pointed out the importance of ¹¹¹In-DTPA-Pentetreotide scintigraphy (Octreoscan) in the preoperative diagnosis of ACTH-producing bronchial carcinoid [2]. Neuroendocrine tumors (of which spectrum bronchial carcinoid are comprised [3]) of the lung and the thymus are most frequently responsible for ectopic ACTH-producing tumors. They express tissue receptors for somatostatin (sst₁–sst₅ subtype receptors) well detected by polymerase chain reaction (PCR) technique. The current generation of somatostatin analogs (octreotide, lanreotide) binds with high affinity to sst₂ receptor subtype, with lower affinity to sst₃ and sst₅, and do not bind sst₁ and sst₄ [4].

In vivo expression of sst₂ receptors is provided by Octreoscan: thus tumors expressing high quantity of these receptors became a potential target for octreotide or lanreotide.

Octreoscan is effective in diagnosing neuroendocrine tumors of the lung (and of the thymus), their eventual metastases to mediastinal lymph nodes and their local or distant recurrences. Distant metastases or recurrences are often discovered in the absence of symptoms with higher accuracy than traditional radiological procedures [5].

We have recorded a recurrence of a radically resected ACTH-producing typical bronchial carcinoid in the mediastinum, promptly discovered by Octreoscan. The patient decided not to be submitted to re-intervention, and he received medical therapy with octreotide, with a good control of the symptoms. Positive Octreoscan can, in fact, influence a medical therapy with octreotide or lanreotide, in case of metastatic neuroendocrine tumors [5]. For example, with prolonged circulating half-life and non-toxic side-effects octreotide is an excellent somatostatin analog for medical application. Recently, radiometabolic treatment with octreotide was proposed in patients with metastatic neuroendocrine tumors: this procedure can be used in selected cases in which surgery is not feasible. Surgery remains, in fact, the treatment of choice in these patients, but not always possible.

We agree with the authors [1] in their diagnostic protocol for neuroendocrine ACTH-producing tumors, and we emphasize the utility of Octreoscan in the preoperative study and follow-up for all neuroendocrine neoplasm of the chest.

References

1. Dall'Asta C., Santambrogio L., Castellani M., Ambrosi B. Difficulties in diagnosis and treatment of ectopic ACTH-producing tumors of the chest. Eur J Cardiothorac Surg 2002;21:149-151.[Abstract/Free Full Text]
2. Oliaro A., Filosso P.L., Casadio C., Ruffini E., Mazza E., Molinatti M., Cianci R., Porrello C., Rastelli M., Oliveri F. Bronchial carcinoid associated with Cushing's syndrome. J Cardiovasc Surg 1995;36:511-514.[Medline]
3. Travis W.D., Colby T.V., Corrin B., Shimosato Y., Brambilla E. Histological typing of lung and pleural tumours, 3rd ed Berlin: Springer, 1999.
4. Patel Y.C., Srikant C.B. Subtype selectivity of peptide analogs for all five cloned human somatostatin receptors (hsstr 1–5). Endocrinology 1994;135:2814-2817.[Abstract]
5. Filosso P.L., Ruffini E., Rena O., Donati G., Oliaro A. Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotide. Eur J Cardiothorac Surg 2002.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pier Luigi Filosso Enrico Ruffini Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Filosso, P. L. Articles by Oliaro, A. Search for Related Content PubMed PubMed Citation Articles by Filosso, P. L. Articles by Oliaro, A. Related Collections Mediastinum