Tuberculosis Mimicking Tumor Progression on Dual-tracer 68Ga-DOTATATE and 18F-FDG PET/CT in Metastatic Neuroendocrine Tumor of Unknown Primary: A Potential Imaging Pitfall in Neuroendocrine Tumor Surveillance.
Rangat Bagasariya, Sunita Sonavane, Sandip Basu
✦ AI-curated · Sources linked
Case in brief
An elderly woman with a metastatic neuroendocrine tumor of unknown primary, who had a partial response to [177Lu]Lu-DOTATATE PRRT, presented with new hypermetabolic cervical lymph nodes on follow-up PET/CT scans. These findings raised concerns for disease progression or a second malignancy. However, histopathological examination revealed granulomatous inflammation consistent with tuberculosis, leading to a reevaluation of her management.
What made this case unusual
The case illustrates how tuberculosis can mimic tumor progression on dual-tracer PET imaging, leading to potential misinterpretation in oncological surveillance.
Diagnostic / clinical pearl
Clinicians should consider infectious etiologies, such as tuberculosis, when interpreting hypermetabolic lymph nodes in patients with a history of malignancy, as they can lead to false-positive imaging results.
Why it matters
This case underscores the importance of histologic confirmation in ambiguous imaging findings to avoid unnecessary changes in cancer management.