Gallbladder Paraganglioma Associated with SDHD Mutation: a Potential Pitfall on 18 F-FDOPA PET Imaging

A 36-year-old male patient initially presented with hypertension, tinnitus, bilateral carotid masses, a right jugular foramen, and a periaortic arch mass with an elevated plasma dopamine level but an otherwise normal biochemical profile. On surveillance MRI 4 years after initial presentation, he was...

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Published inNuclear medicine and molecular imaging Vol. 53; no. 2; p. 144
Main Authors Abdul Sater, Zahraa, Jha, Abhishek, Mandl, Adel, Mangelen, Sheila K, Carrasquillo, Jorge A, Ling, Alexander, Gonzales, Melissa K, Lopes Abath Neto, Osorio, Miettinen, Markku, Adams, Karen T, Nockel, Pavel, El Lakis, Mustapha, Pacak, Karel
Format Journal Article
LanguageEnglish
Published Germany 01.04.2019
Subjects
68Ga-DOTATATE
Paraganglioma
Gallbladder
18F-FDG
SDHD
18F-DOPA
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Summary:A 36-year-old male patient initially presented with hypertension, tinnitus, bilateral carotid masses, a right jugular foramen, and a periaortic arch mass with an elevated plasma dopamine level but an otherwise normal biochemical profile. On surveillance MRI 4 years after initial presentation, he was found to have a 2.2-cm T2 hyperintense lesion with arterial enhancement adjacent to the gallbladder, which demonstrated avidity on Ga-DOTATATE PET/CT and retrospectively on F-FDOPA PET/CT but was non-avid on F-FDG PET/CT. Biochemical work-up including plasma catecholamines, metanephrines, and chromogranin A levels were found to be within normal limits. This lesion was surgically resected and was confirmed to be a paraganglioma (PGL) originating from the gallbladder wall on histopathology. Pheochromocytoma (PHEO) and PGL are rare tumors of the autonomic nervous system. Succinate dehydrogenase subunit D ( ) pathogenic variants of the succinate dehydrogenase complex are usually involved in parasympathetic, extra-adrenal, multifocal head, and neck PGLs. We report an unusual location of PGL in the gallbladder associated with mutation which could present as a potential pitfall on F-FDOPA PET/CT as its normal excretion occurs through biliary system and gallbladder. This case highlights the superiority of Ga-DOTATATE in comparison to F-FDOPA and F-FDG in the detection of -related parasympathetic PGL. ClinicalTrials.gov Identifier: NCT00004847.
ISSN:1869-3474