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KMID : 1148920190530020144
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Nuclear Medicine and Molecular Imaging
2019 Volume.53 No. 2 p.144 ~ p.147
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Gallbladder Paraganglioma Associated with SDHD Mutation: a Potential Pitfall on 18F-FDOPA PET Imaging
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Sater Zahraa Abdul
Jha Abhishek
Mandl Adel
Mangelen Sheila K.
Carrasquillo Jorge A.
Ling Alexander
Gonzales Melissa K.
Neto Osorio Lopes Abath
Miettinen Markku
Adams Karen T.
Nockel Pavel
El Lakis Mustapha
Pacak Karel
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Abstract
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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 68Ga-DOTATATE PET/CT and retrospectively on 18F-FDOPA PET/CT but was non-avid on 18F-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 18F-FDOPA PET/CT as its normal excretion occurs through biliary system and gallbladder. This case highlights the superiority of 68Ga-DOTATATE in comparison to 18F-FDOPA and 18F-FDG in the detection of SDHD-related parasympathetic PGL.
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KEYWORD
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Gallbladder, Paraganglioma, SDHD, 68Ga-DOTATATE, 18F-DOPA, 18F-FDG
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