68Ga-DOTATATE PET/CT Distinguishes Neuroendocrine Tumor Mesenteric Lymph Node Metastasis From an Extensive IgG4-Positive Fibrosis Surrounding It

Abstract

A 56-year-old woman presented with right iliac fossa pain. Abdominal CT showed a mesenteric mass in the right iliac fossa, adjacent to the vena cava inferior and right ureter. Biopsy of the mass revealed a well-differentiated neuroendocrine tumor. 68Ga-DOTATATE PET/CT showed strong somatostatin receptor expression only within in a small, central area of this mesenteric mass, with faint 68Ga-DOTATATE uptake in the majority of this mesenteric mass. Pathology revealed an IgG4-positive storiform fibrosis surrounding a mesenteric adenopathy. 68Ga-DOTATATE PET/CT discriminates between neuroendocrine tumor lymph node metastases and fibrosis, hereby avoiding potential sampling error of tumor biopsies and guiding surgical approach.

Outcome prediction of SSTR-RADS-3A and SSTR-RADS-3B lesions in patients with neuroendocrine tumors based on 68Ga-DOTATATE PET/MR

“…Metastatic LNs typically show active 68 Ga-DOTATATE metabolism, LN enlargement, and elevated SUV (Ahmadi Bidakhvidi et al 2021 ). In this study, LNs classified as SSTR-RADS 3A, whether metastatic or non-metastatic, had similar SUVmax values, likely due to their small size and the limited resolution of PET imaging (Xie et al 2021 ).…”

Peptide Receptor Radionuclide Therapy Targeting the Somatostatin Receptor: Basic Principles, Clinical Applications and Optimization Strategies

“…The QoL in NET patients is lower compared to the general population and is mostly affected by tumoral mass effects and/or hormone production [ 77 ]. NETs can produce biogenic amines and peptides, which can induce a range of hormonal syndromes, e.g., serotonin production, leading to carcinoid syndrome and fibrosis [ 78 , 79 , 80 ]. The main symptoms of carcinoid syndrome include flushing, diarrhea and to a lesser extent bronchospasm.…”