Incidental Diagnosis of Multiple Paragangliomas by Ga-68 DOTANOC Positron Emission Tomography-Computed Tomography

Document Type : Case report

Authors

Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Abstract

A 65-year-old man presented with intermittent abdominal pain for three months. Abdominal ultrasonography revealed a mass in the body of the pancreas. Moreover, abdominal contrast-enhancing computed tomography revealed a homogenously enhancing mass in the body of the pancreas. Scan findings were in favor of the neuroendocrine tumor, and the serum chromogranin level was slightly raised (111.9 ng/ml, normal <98). He had no history of vomiting, jaundice, melena, hematemesis, constipation, diarrhea, weight gain, weight loss, loss of appetite, and fever. He also had no symptoms related to the excessive production of catecholamines, such as hypertension. The patient was referred for Ga-68 DOTANOC positron emission tomography-computed tomography (Ga-68 DOTANOC PET-CT) for further evaluation. The scan was done to rule out metastatic disease or other synchronous lesions to plan surgical excision. The Ga-68 DOTANOC PET-CT revealed a pancreatic lesion with no other abdominal lesions. We noted multiple tracer avid soft tissue lesions on both sides of the neck that were not diagnosed previously. This case report demonstrates a rare case with multiple paragangliomas diagnosed by the Ga-68 DOTANOC PET-CT. This finding could lead to changes in patient management

Keywords


1. Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec; 58(12):802–4 .
2. Nölting S, Ullrich M, Pietzsch J, Ziegler CG, Eisenhofer G, Grossman A, et al. Current Management of Pheochromocytoma/ Para ganglioma: A Guide for the Practicing Clinician in the Era of Precision Medicine. Cancers. 2019 Oct 8; 11(10).
3. Kliewer KE, Wen DR, Cancilla PA, Cochran AJ. Paragangliomas: assessment of progno-sis by histologic, immunohistochemical, and ultrastructural techniques. Hum Pathol. 1989 Jan; 20(1):29–39 .
4. Eisenhofer G, Klink B, Richter S, Lenders JW, Robledo M. Metabologenomics of Phaeo-chromocytoma and Paraganglioma: An Integrated Approach for Personalised Biochemical and Genetic Testing. Clin Biochem Rev. 2017 Apr; 38(2):69–100 .
5. Timmers HJLM, Chen CC, Carrasquillo JA, Whatley M, Ling A, Eisenhofer G, et al. Staging and functional characterization of pheochromocytoma and paraganglioma by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography. J Natl Cancer Inst. 2012 May 2; 104(9):700–8 .
6. Han S, Suh CH, Woo S, Kim YJ, Lee JJ. Performance of 68Ga-DOTA-Conjugated Somatostatin Receptor-Targeting Peptide PET in Detection of Pheochromocytoma and Paraganglioma: A Systematic Review and Metaanalysis. J Nucl Med Off Publ Soc Nucl Med. 2019; 60(3):369–76 .
7. Plouin PF, Amar L, Dekkers OM, Fassnacht M, Gimenez-Roqueplo AP, Lenders JWM, et al. European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma. Eur J Endocrinol. 2016 May; 174(5):G1–10 .
8. Lu L, Yang Z, Zhang G, An B, Lin Y, Zheng X. Challenges in the surgical treatment of undiagnosed functional paragangliomas: A case report. Medicine (Baltimore). 2018 Sep; 97(38):e12478 .
9. Blake MA, Kalra MK, Maher MM, Sahani DV, Sweeney AT, Mueller PR, et al. Pheochro-mocytoma: an imaging chameleon. Radio Rev Publ Radiol Soc N Am Inc. 2004 Oct; 24 Suppl 1:S87-99 .
10. Opocher G, Schiavi F. Genetics of pheochromocytomas and paragang-liomas. Best Pract Res Clin Endocrinol Metab. 2010 Dec; 24(6):943–56 .
11. Wen J, Li H-Z, Ji ZG, Mao QZ, Shi BB, Yan WG.
A decade of clinical experience with extra-adrenal paragangliomas of retroperito-neum: Report of 67 cases and a literature review. Urol Ann. 2010 Jan; 2(1):12–6 .
12. Magliulo G, Zardo F, Varacalli S, D’Amico R. Multiple paragangliomas of the head and neck. An Otorrinolaringol Ibero-Am. 2003; 30(1):31–8 .
13. Aygun N, Uludag M. Pheochromocytoma and Paraganglioma: From Epidemiology to Clinical Findings. Sisli Etfal Hassan Tip Bul. 2020; 54(2):159–68 .
14. Ramage JK, Davies AHG, Ardill J, Bax N, Caplin M, Grossman A, et al. Guidelines for the management of gastroentero-pancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005 Jun; 54 Suppl 4:iv1-16.