Simultaneous DOTATATE uptake in three non-neuroendocrine pathologies: Follicular lymphoma, Crohn's disease, and...

Gallium-68 (⁶⁸Ga) DOTATATE positron emission tomography/computed tomography (PET/CT) has emerged as the gold standard imaging modality for neuroendocrine tumors (NETs). However, false-positive uptake in non-NET pathologies can be a diagnostic dilemma. The authors report a case of a 70-year-old woman presenting with recurrent small bowel obstructions, chronic diarrhea, and progressive weight loss. CT imaging demonstrated high-grade small bowel obstruction with marked bowel wall thickening and confluent mesenteric and retroperitoneal lymphadenopathy that had progressively increased over the prior year, raising clinical suspicion for NET. DOTATATE PET/CT revealed elevated uptake in the terminal ileum, mesenteric and retroperitoneal lymph nodes, and L4 vertebral body, a distribution that was suspicious for metastatic small bowel NET. However, tissue confirmation and correlation with anatomic imaging established 3 concurrent non-NET diagnoses: grade 3A follicular lymphoma, Crohn's disease, and a benign vertebral hemangioma. Simultaneous DOTATATE uptake in multiple distinct entities represents a diagnostic challenge requiring careful correlation of metabolic, anatomic, clinical, and pathologic data.