[68Ga] Ga-Pentixafor diffuse bilateral Adrenal & Breast uptake in a patient with High-grade Glioma: A note of caution on normal variants

Document Type : Case report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants.

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  1. Lapa C, Lückerath K, Kleinlein I, Monoranu CM, Linsenmann T, Kessler AF,et al. 68Ga-pentixafor-PET/CT for imaging of chemokine receptor4 expression in glioblastoma. 2016; 6(3):428.
  2. Jacobs SM, Wesseling P, de Keizer B, Tolboom N, Ververs FF, Krijger GC,et al. CXCR4 expression in glioblastoma tissue and the potential for PET imaging and treatment with [68Ga] Ga-Pentixafor/ [177Lu]Lu-Pentixather. European journal of nuclear medicine and molecular imaging. 2022; 49(2):481-91.
  3. Kircher M, Herhaus P, Schottelius M, Buck AK, Werner RA, Wester HJ, et al. CXCR4-directed theranostics in oncology and inflammation. Annals of Nuclear Medicine. 2018; 32(8):503-11.
  4. Herrmann K, Lapa C, Wester HJ, et al. Biodistribution and radiation dosimetry for the chemokine receptor CXCR4-targeting probe 68Ga-pentixafor. J Nucl Med. 2015; 56:410-416.
  5. Vag T, Steiger K, Rossmann A, Keller U, Noske A, Herhaus P, et al. PET imaging of chemokine receptor CXCR4 in patients with primary and recurrent breast carcinoma. EJNMMI research. 2018; 8(1):1-9.
  6. Zhang Z, Ni C, Chen W, Wu P, Wang Z, Yin J, et al. Expression of CXCR4 and breast cancer prognosis: a systematic review and meta-analysis. BMC cancer. 2014; 14(1):1-8.
  7. Laird SM, Widdowson R, El-Sheikhi M, Hall AJ, Li TC. Expression of CXCL12 and CXCR4 in human endometrium; effects of CXCL12 on MMP production by human endometrial cells. Human reproduction. 2011; 26(5): 1144-52.
  8. Ding J, Zhang Y, Wen J, Zhang H, Wang H, Luo Y, et al. Imaging CXCR4 expression in patients with suspected primary hyper-aldosteronism. European journal of nuclear medicine and molecular imaging. 2020; 47(11):2656-65.
  9. Heinze B, Fuss CT, Mulatero P, Beuschlein F, Reincke M, Mustafa M, et al. Targeting CXCR4 (CXC chemokine receptor type 4) for molecular imaging of aldosterone-producing adenoma. Hypertension. 2018; 71(2):317-25.
  10. Ding J, Tong A, Zhang Y, Zhang H, Huo L. Cortisol-producing adrenal adenomas with intense activity on 68Ga-pentixafor PET/CT. Clinical Nuclear Medicine. 2021; 46(4):350-2.