Octreotide scanning in the detection of metastatic renal cell carcinoma

A 63-year-old lady underwent right-sided nephrectomy for renal cell carcinoma (RCC) in 1991. She required a further nephrectomy in 2003 for RCC in the contralateral side rendering her haemodialysis dependent. Following 2-year disease free survival she was considered for transplantation. An initial CT scan of the abdomen in 2005 raised the possibility of bone metastases, promoting further investigation; however, isotope bone scanning and MRI revealed degenerative changes only. Her oncologist advised yearly surveillance CT scans following transplant listing. Following the routine work-up she was activated on the UK transplant deceased donor waiting list. A CT scan in 2007 demonstrated two hyperdense lesions within the head and body of the pancreas, and a radioisotope octreotide scan was performed to exclude a non-functional neuroendocrine tumour. Appearances on the 24 and 48 h octreotide images demonstrated intense tracer accumulation within the left gluteus medius and the right-proximal vastus medialis muscles, confirmed on single photon emission computed tomography (SPECT) (Figure 1). An ultrasound-guided muscle biopsy of the rightproximal vastus medialis muscle was performed which demonstrated a highly vascular clear cell tumour in keeping with metastatic RCC. Endoscopic ultrasound-guided fine needle aspiration (FNA) of the pancreatic lesions also demonstrated a vascular clear cell tumour. The patient remains completely asymptomatic. Given the low volume and