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  • Teaching Cases in Nuclear Oncology:Pediatric Cancers

    Duccio Volterrani, Giulia Puccini, Sara Mazzarri, FedericaGuidoccio, and Lorenzo Biassoni

    Contents

    Neuroblastoma: Case No. 1 . . . . . . . . . . . . . . . . . . . . . . . . . 2Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

    Neuroblastoma: Case No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . 3Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

    Neuroblastoma: Case No. 3 . . . . . . . . . . . . . . . . . . . . . . . . . 5Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

    Neuroblastoma: Case No. 4 . . . . . . . . . . . . . . . . . . . . . . . . . 7Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

    Neuroblastoma: Case No. 5 . . . . . . . . . . . . . . . . . . . . . . . . . 9Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Teaching Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

    Neuroblastoma: Case No. 6 . . . . . . . . . . . . . . . . . . . . . . . . . 13

    Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Teaching Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

    Neuroblastoma: Case No. 7 . . . . . . . . . . . . . . . . . . . . . . . . . 14Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

    Neuroblastoma: Case No. 8 . . . . . . . . . . . . . . . . . . . . . . . . . 16Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

    Lymphoma: Case No. 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

    Ewing Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

    Lymphoma: Case No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

    D. Volterrani (*) G. Puccini S. Mazzarri F. GuidoccioRegional Center of Nuclear Medicine, University of Pisa,Pisa, Italye-mail: duccio.volterrani@med.unipi.it

    L. BiassoniNuclear Medicine Service, Great Ormond Street Hospital,London, UK

    # Springer International Publishing AG 2016H.W. Strauss et al. (eds.), Nuclear Oncology,DOI 10.1007/978-3-319-26067-9_80-1

    1

    mailto:duccio.volterrani@med.unipi.it
  • Lymphoma: Case No. 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Teaching Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

    Neuroblastoma: Case No. 9 . . . . . . . . . . . . . . . . . . . . . . . . . 24Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

    KeywordsNeuroblastoma [123I]MIBG MRI Contrastenhanced CT 68Ga-DOTATATE 177Lu-DOTATATE molecular radiotherapy Ganglioneuroblastoma Diffuse large B-celllymphoma [18F]FDG PET/CT Ewing sar-coma Hodgkins lymphoma Chemotherapy

    Glossary[123I]MIBG [123I]-meta-

    Iodobenzylguanidine[131I]MIBG [131I]-meta-

    Iodobenzylguanidine[18F]FDG 2-Deoxy-2-[18F]fluoro-D-

    glucose18F-DOPA 2-18F-Fluoro-L-3,4-

    dihydroxyphenylalanineABVD Chemotherapy regimen based

    on adriamycin, bleomycin, vin-blastine, and dacarbazine

    ceCT Contrast-enhanced computedtomography

    COJEC Chemotherapy regimen basedon cisplatin, vincristine,carboplatin, etoposide, andcyclophosphamide

    CT X-ray computed tomographyDLBCL Diffuse large B-cell lymphomaDOTA 1,4,7,10-Tetra-

    azacyclododecane-1,4,7,10-tetraacetic acid

    DOTANOC DOTA-1-Nal3-octreotideDOTATATE DOTA-Tyr3-octreotateGy Gray unit (ionizing radiation

    dose in the International Systemof Units, corresponding to theabsorption of one joule of radi-ation energy per kilogram ofmatter)

    HASTE Half-Fourier acquisition singleshot turbo spine echo, a mag-netic resonance imagingtechnique

    HVA Homovanillic acid, a dopaminemetabolite

    IVC Inferior vena cavaMAP2 Microtubule-associated

    protein-2

    2 D. Volterrani et al.

  • MIBG meta-IodobenzylguanidineMIP Maximum intensity projectionMR Magnetic resonanceMRI Magnetic resonance imagingMYCN Gene encoding for the N-myc

    proto-oncogene protein, alsoknown as N-Myc or basic helix-loop-helix protein 37(bHLHe37)

    NCCN National Comprehensive Can-cer Network

    NSE Neuron-specific enolasePET Positron emission tomographyPET/CT Positron emission tomography/

    Computed tomographyRCHOP Chemotherapy regimen based

    on rituximab, cyclophospha-mide, doxorubicin

    SPECT Single-photon emission com-puted tomography

    SPECT/CT Single-photon emission com-puted tomography/Computedtomography

    STIR Short tau inversion recovery, amagnetic resonance imagingtechnique used for fat suppres-sion (also known as short T1inversion recovery)

    SUV Standardized uptake valueSUVmax Standardized uptake value at

    point of maximumSVC Superior vena cavaTVD Chemotherapy regimen based

    on topotecan, vincristine, anddoxorubicin vincristine, andprednisone

    VMA Vanyllilmandelic acid, a cate-cholamine metabolite

    Neuroblastoma: Case No. 1

    Presentation

    A four-year-old girl with high-risk neuroblastoma(stage IV, MYCN amplified). Treated with induc-tion chemotherapy (modified N7 protocol), with

    partial response (persisting 510% positive bonemarrow cells on bilateral trephines). Second-lineinduction chemotherapy with TVD, with someimprovement, but still about 5% positivity onbone marrow trephines. Further treatment withbevacizumab and temozolomide, with goodresponse. Surgery, with 80% tumor removal andleft nephrectomy (tumor invasion of the left renalhilum).

    Findings

    Persisting disease on reassessment [123I]MIBG(Fig. 1). The child has subsequently been treatedwith experimental therapies including monoclonalantibodies and modified T-cells. MRI scan afterfifth cycle of monoclonal anti

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