TeleNEN as a telemedicine model for neuroendocrine neoplasm management in case of Meckel's diverticulum NET.

A case of a 25-year-old female with NET deriving from Meckel's diverticulum is described. The patient had a one-year history of dermatological skin problems. Ultrasound examination of the abdomen, performed because of arterial hypertension, revealed multiple hepatic lesions, which was confirmed in contrast-enhanced CT. The typical contrast-enhanced metastatic lesions in CT and elevated levels of chromogranin A suggested NET of unknown origin. SRS with Tc-99m-HYNICTOC was perform for primary tumor localisation, revealing liver and paraaortic lymph node metastases but no sign of primary tumour location. As a next step for primary tumour localisation Ga-68 DOTATATE PET/CT was performed, which revealed a focus of increased uptake in the small intestine, considered to be the primary tumour site. The imaging and clinical history of patient was discussed on TeleNEN (a novel model for the application of telemedicine in management of NEN). Due to the location of the primary tumour in the small intestine with no anatomical changes in CT, laparotomy guided with gamma probe after Ga-68-DOTATATE injection was performed. During the surgery procedure, the primary tumour was hardly palpable in the tip of Meckel's diverticulum, confirmed by gamma probe. After surgery, tandem peptide receptor radionuclide therapy (PRRT) was started. The patient received four doses of Y-90/Lu-177-DOTATATE with total activity of 360 mCi (13.32 GBq). The three-month follow-up Ga-68-DOTATATE PET/CT showed stable disease in the patient. The presented case shows the importance of the role of a multidisciplinary team cooperating in patient management. Use of RGS is essential in cases like the one presented, when the tumour cannot be localised only by surgical palpation.