Abstract
We present a case of metastatic neuro-endocrine carcinoma of the lower end of the oesophagus, rare as for the primary tumour site. Somatostatin Receptor scintigraphy with ^99mTc-EDDA/HYNIC-octreotate findings altered the patient's management from curative surgery to palliative chemotherapy. The patient presented with progressive dysphagia and was histopathologically diagnosed on biopsy of the mass at the lower end of the oesophagus as high-grade neuroendocrine carcinoma. Baseline investigations showed deranged liver function, but except for a thickened gastro-esophageal junction, there was no abnormality seen on the initial computerized tomography scan. Also, raiologically, there was no evidence of metastatic disease seen either in the liver or the bones. Prior to surgical intervention, which was decided in the institutional tumour board, the patient was referred to the department of nuclear medicine for somatostatin receptor scintigraphy with ^99mTc-EDDA/HYNIC-octreotate. The images demonstrated widespread metastatic disease in the liver, bones and abdominal lymph nodes. The osseous lesions correlated well with abnormal tracer foci seen on subsequent bone scintigraphy. Moreover, scanning was completed within twenty-four hours with high-quality images produced owing to the ideal physical characteristics of technetium-99m. On the basis of the findings of the somatostatin receptor scintigraphy, the management changed from curative surgery to palliative chemotherapy. The patient however was unresponsive to combination chemotherapy and eventually expired five months after the initial diagnosis due to disease progression.