Gluteal Nodules in Patients with Metastatic Midgut Carcinoid Disease Treated with Depot Somatostatin Analogs

Abstract

Patients with metastatic midgut carcinoid tumors have large numbers of asymptomatic sc nodules in the gluteal area when on either depot somatostatin analog, but these resolve over time. This clear observation gives reassurance to patients and those managing them that such nodules are unlikely to represent metastases.

Large fat and skin necroses after deep subcutaneous injections of a slow-release somatostatin analogue in a woman with acromegaly

“…In a recent publication asymptomatic subcutaneous nodules, on average 1 cm in size, were frequently observed in patients with carcinoid disease following longterm treatment with depot formulations of octreotide and lanreotide, with a tendency to be more common after administration of lanreotide [4]. In another study, biopsy of a nodule at an early stage showed an inflammatory reaction surrounding a cyst of exogenous material, with subsequent development of a foreign-body granuloma [5].…”

Diagnostic approach to subcutaneous nodules in patients with neuroendocrine tumours treated with depot somatostatin analogs: a cross‐sectional study

“…They are frequently multiple, often with poorly defined borders and associated with hazy changes in the adjacent subcutaneous fat. 6 These CT findings cannot usually distinguish between SSAs-related nodules and metastases. Sonographic findings have not been previously reported for these nodules.…”

“…In previous studies, CT scans showed nodules associated with SSAs injections to be generally located in the subcutaneous fat of the gluteal region. They are frequently multiple, often with poorly defined borders and associated with hazy changes in the adjacent subcutaneous fat . These CT findings cannot usually distinguish between SSAs‐related nodules and metastases.…”

“…While nodules at the injection site have been reported to be infrequent in patients under treatment with SSAs, subcutaneous nodules were found in up to 52% of computed tomography (CT) scans performed in 56 patients with metastatic midgut carcinoid tumours receiving SSAs . Subcutaneous tissue metastases, although rare in GEP‐NETs, have been described as a late manifestation and an important predictor of death .…”

“…tomography (CT) scans performed in 56 patients with metastatic midgut carcinoid tumours receiving SSAs. 6 Subcutaneous tissue metastases, although rare in GEP-NETs, have been described as a late manifestation and an important predictor of death. 7 Sonography, which has already proved its role in the evaluation of skin lesions, 8 could be very useful in the differential diagnosis of subcutaneous nodules in patients with GEP-NETs.…”