Indium-111 pentetreotide imaging of carcinoid tumor of the thymus

Carcinoid tumors are relatively rare and can occur in the thorax, abdomen, or pelvis. Indium-111 pentetreotide scanning is useful for the identification of these tumors. In this report, we present imaging findings and discussion pertaining to a 43-year-old man who presented with Cushing's syndrome resulting from a thymic carcinoid tumor. The imaging is of interest because there is not only marked uptake of In-111 pentetreotide in the thymic carcinoid tumor, but also within the adrenal glands attributable to elevated tumor-derived ACTH.

Planar and single-photon emission computed tomography (SPECT) images of the chest and abdomen were obtained 15 minutes after the injection of 6.6 mCi of In-111 pentetreotide. Further planar and SPECT images were obtained approximately 4 and 24 hours after injection of the radiopharmaceutical. Correlation of In-111 pentetreotide SPECT was made with laboratory results and CT evaluation of the chest and abdomen.

Initial clinical workup for Cushing's syndrome included a contrast-enhanced brain magnetic resonance image that showed a small pituitary lesion thought to represent a microadenoma. Normal inferior petrosal venous sinus sampling for ACTH suggested there was an ectopic ACTH source. Subsequent CT of the chest identified a 3 x 3-cm enhancing mediastinal mass. Avid uptake within the mass on In-111 pentetreotide images suggested that the underlying cause of Cushing's syndrome was ACTH production from a thymic carcinoid. Increased uptake of In-111 pentetreotide was also noted within hyperplastic adrenal glands. Surgical resection and histologic evaluation established the diagnosis of a moderately differentiated thymic carcinoid tumor.

This case illustrates the complementary ability of In-111 pentetreotide planar and SPECT imaging and CT to diagnose an ACTH-producing thymic carcinoid tumor leading to adrenal hyperplasia and Cushing's syndrome.