Coexisting somatostatin receptor expressing gastric neuroendocrine tumor primary and lymph nodal tuberculosis on ⁶⁸ Ga-DOTANOC positron emission tomography/computed tomography

Gastric neuroendocrine tumors (G-NETs) express somatostatin receptors (SSTR), which can be imaged using radiolabeled somatostatin analogs, including 68Ga-DOTA octreotide analogs. SSTR expression is also seen in activated lymphocytes and macrophages, which might result in false-positive results on SSTR imaging, in patients with coexistent granulomatous pathologies including tuberculosis, sarcoidosis, and Wegener's granulomatosis. We present a case where 68Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) showed primary G-NET, with SSTR expressing nonregional lymph nodes which on histopathology showed necrotizing granulomas with Langhans histiocytes. Antitubercular therapy was started, and a decrease in size and SSTR expression in involved lymph nodes was noted on follow-up 68Ga-DOTANOC PET/CT.