Presentation
Hepatic metastatic disease - neuroendocrine tumor on biopsy. Unknown site of the primary lesion.
Patient Data
Focal intense uptake localizing to the appendix consistent with a primary neuroendocrine tumor.
Intense uptake of tracer associated with a spiculated, partly calcified mass in the right mesentery. Subcentimeter but focally avid mesenteric lymph node inferiorly and laterally to the dominant nodal mass, in the region of the appendix.
Innumerable DOTATATE avid lesions throughout the liver consistent with hepatic metastatic disease. High density within some liver lesions secondary to prior TACE procedure.
The green arrow indicates the site of the primary appendiceal neuroendocrine tumor.
The pink arrow indicates the intense DOTATATE uptake associated with the spiculated, partly calcified mesenteric nodal mass.
Case Discussion
Ga68-DOTATATE PET/CT is used for assessment of well-differentiated neuroendocrine tumors which maintain somatostatin receptor expressivity.
A proportion of patients with gastrointestinal neuroendocrine tumors will present with nodal and/or hepatic metastases at presentation, with the primary lesion occult on diagnostic CT imaging. Ga68-DOTATATE PET/CT can play a valuable role in these patients by localizing the site of the primary lesion - which may be small in size (as in this case) or in a difficult to image anatomical location (such as small bowel).
Appendiceal neuroendocrine tumors (carcinoid tumors) are the most common primary neoplasm of the appendix.
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