Triple Tracer Positivity in Metastatic Lymph Nodes from Well-Differentiated Neuroendocrine Tumor in MEN-1 Syndrome

Abstract

Patients with multiple endocrine neoplasia type 1 usually have a combination of endocrine disorders due to lesions in the pancreas, parathyroid gland, and pituitary gland. Functional imaging using different tracers in addition to conventional imaging are applied in localizing the primary sites, determining the disease extent, and characterizing the lesions. We present a diagnosed case of multiple endocrine neoplasia type 1 with interesting incidental imaging findings showing ^99mTc-sestamibi and ¹⁸F-fluorocholine uptake in addition to ⁶⁸Ga-DOTANOC uptake in metastatic mediastinal and cervical lymph nodes arising from gastroenteropancreatic neuroendocrine tumor. This case shows the possibility of imaging the neuroendocrine tumors with 3 different tracers, namely ⁶⁸Ga-DOTANOC, ^99mTc-sestamibi, and ¹⁸F-fluorocholine.