Small Bowel Leiomyoma Mimics Neuroendocrine Tumor on 68 Ga-DOTATATE PET/CT

A 57-year-old man with a 3-month history of lower abdominal pain and rectal bleeding with black stools underwent urgent abdominal CT, which revealed an ovoid hyperdense lesion in the ileum in the right iliac fossa. The prime differential was a midgut neuroendocrine tumor. Thus, the patient was referred for a 68 Ga-DOTATATE PET/CT scan, which demonstrated intense activity in this lesion with no evidence of somatostatin receptor expression elsewhere. Surgical small bowel resection later revealed a small bowel leiomyoma, which was confirmed on immunohistochemistry analysis. This case demonstrates that leiomyomas can express somatostatin receptors and can be a false-positive on 68 Ga-DOTATATE PET/CT scan.