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

• Published in: Nuclear medicine and molecular imaging Vol. 53; no. 2; pp. 144 - 147
• 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
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2019; Springer Nature B.V; 대한핵의학회
• Subjects: Arches; Autonomic nervous system; Cardiology; Case Report; Dehydrogenases; Dopamine; Excretion; Fluorine isotopes; Gallbladder; Head; Hypertension; Imaging; Medicine; Medicine & Public Health; Mutation; Nuclear Medicine; Oncology; Orthopedics; Positron emission; Radiology; Tinnitus; Tomography; 방사선과학; Paraganglioma; Gallbladder; F-FDG; Ga-DOTATATE; F-DOPA
• ISSN: 1869-3474; 1869-3482
• DOI: 10.1007/s13139-018-0558-1

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
68
Ga-DOTATATE PET/CT and retrospectively on
18
F-FDOPA PET/CT but was non-avid on
18
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 (
SDHD
) 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
SDHD
mutation which could present as a potential pitfall on
18
F-FDOPA PET/CT as its normal excretion occurs through biliary system and gallbladder. This case highlights the superiority of
68
Ga-DOTATATE in comparison to
18
F-FDOPA and
18
F-FDG in the detection of
SDHD
-related parasympathetic PGL.
ClinicalTrials.gov Identifier:
NCT00004847
.