Gluteal hemangioma mimicking a neuroendocrine tumor: pitfalls in neuroendocrine tumor diagnostic testing

Somatostatin receptor scanning with radiolabeled somatostatin analogues is an important modality for localizing neuroendocrine tumors (NETs) but may also show activity in normal tissues and non-NET pathologies. A patient with a history of a parathyroid adenoma, papillary thyroid carcinoma, and acoustic neuroma was suspected of harboring a NET based upon 2 circulating tumor nucleic acid tests that used different methodology and a positive ⁶⁸gallium-dodecanetetraacetic acid-tyrosine-3-octreotate (⁶⁸Ga-DOTATATE) scan corresponding to a 2.2-cm right gluteal mass, which was found to be an intramuscular hemangioma expressing somatostatin receptor 2 subtype (SSTR2) in the endothelial cells. Hemangiomas are among the most frequently reported lesions mimicking a NET and should be considered when somatostatin receptor scanning localizes an isolated lesion in an unusual anatomic area.