Vascular thrombosis as a cause of abdominal pain in a patient with neuroendocrine carcinoma of pancreas: Findings on 68Ga-DOTANOC PET/CT
A 53-year-old female was diagnosed with a pancreatic tumor when she initially presented with anorexia and weight loss. Contrast-enhanced CT (CECT) examination at that time revealed a large, homogenous enhancing mass involving almost the entire pancreas with no evidence of local invasion or nodal involvement. A biopsy examination of pancreatic tissue revealed features of a well-differentiated tumor of neuroendocrine origin (neuroendocrine carcinoma proliferating index, 4%). In view of extensive disease involving pancreas, surgery was deferred and the patient was put on octreotide therapy. The patient was apparently well for a period of 4 months when she started having abdominal pains, which progressed in severity over the next month. A repeat contrast-enhanced examination of the abdomen revealed no significant alterations of the primary pancreatic mass, but showed numerous filling defects within the mesenteric vasculature. In view of the disease progression, a staging PET/CT using 68Ga-DOTANOC was performed []. Intense radiotracer uptake was noted in the primary tumor (SUVmax-53). Also seen was an arborizing area of abnormal tracer uptake within the abdomen, which was subsequently traced to mesenteric vessels []. Thus, 68Ga-DOTANOC PET/CT helped confirm the presence of mesenteric vascular thrombosis and localize the cause of abdominal pain to be the same. In addition, the whole body examination revealed no other areas of abnormal uptake that could suggest presence of other metastatic sites.