Neoadjuvant peptide receptor radionuclide therapy for an inoperable neuroendocrine pancreatic tumor

Figure 1 Histological images. A: Lymph node metastasis of a high differentiated neuroendocrine carcinoma of the pancreas showing a trabecular pattern (HE, × 120); B The cells are positive for synaptophysin (× 120); C: High membranous expression of somatostatin-receptor SSTR-2 (× 120); D: Macrophages (CD68-positive) as a sign for tumor necrosis after PRRT (× 120).

Figure 2 Gallium-68 DOTA-NOC PET-CT in the follow up. A: Octreotide scan prior to PRRT-1, Gallium-68 DOTA NOC PET-CT and prior operation, showing multiple paraaortal lymph nodes next to the pancreas head; B: 3 mo after PRRT-1; C: 5 mo after PRRT-2 showing consistently decreasing mesenterial lymph nodes metastases with a decreasing SUV; D: Octreotide scan as follow up 18 mo after operation-complete remission.

Figure 3 The pancreatic tumor with lymph node metastases (peripancreatic and one distal mesenteric lymph node metastasis) after pylorus-preserving duodenopancreatectomy and mesenteric lymphadenectomy en bloc.