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Case Report
Pancreatic serous cystadenoma with a high 68Ga DOTATOC-uptake mimicking a pancreatic NET
1 Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
2 Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
3 Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
4 Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
5 Department of Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
Address correspondence to:
Erling A Bringeland
Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim,
Norway
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Article ID: 100097Z04EB2022
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Bringeland EA, Rønne E, Kjellmo Å, Keil TM. Pancreatic serous cystadenoma with a high 68Ga DOTATOC-uptake mimicking a pancreatic NET. Int J Hepatobiliary Pancreat Dis 2022;12:100097Z04EB2022.ABSTRACT
Introduction: 68Ga-DOTATOC positron emission tomography (PET) has replaced octreotide scintigraphy as method of choice in detecting and staging most neuroendocrine tumors (NETs). With a better signal-to-noise ratio and improved spatial resolution, sensitivity is increased. However, several non-NETs express surface somatostatin receptors, challenging the positive predictive value of a DOTATOC scan regarding a NET diagnosis. This is of particular concern in pancreas as NET is a frequent differential diagnosis, as is a variety of cystic neoplasms increasingly often diagnosed as incidental findings.
Case Report: A 66-year-old man was diagnosed with an asymptomatic cystic tumor in the pancreatic neck. At computed tomography scan (CT) a 4 cm P-NET was suspected as an incidental finding. The diagnosis was supported by a positive 68Ga-DOTATOC scan, with a high DOTATOC-uptake in the pancreatic tumor and in a local interaortocaval node. The tumor was radically resected. At pathologic examination a pancreatic serous cystadenoma (SCN) was unexpectedly diagnosed, with the regional nodes proven only to harbor granulomatous inflammation.
Conclusion: A rare case of a 68Ga-DOTATOC positive SCN is reported. Diagnostic workup was confounded by a local node exhibiting a high DOTATOC-uptake. Radiologists, nuclear medicine physicians, and pancreatic surgeons must be aware of this diagnostic pitfall to avoid unnecessary surgical procedures.
Keywords: 68Ga-DOTATOC PET-CT, Pancreatic cystic neoplasm, Pancreatic neuroendocrine tumor, Pancreatic nuclear imaging, Pancreatic serous cystoadenoma
SUPPORTING INFORMATION
Author Contributions
Erling A Bringeland - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Elin Rønne - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Åse Kjellmo - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Thomas M Keil - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Erling A Bringeland et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
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