False positive of 68Ga-DOTATATE PET-CT in a paraganglioma

Functional imaging with 68Ga-DOTATATE PET-CT is widely employed to detect both primary and metastatic pheochromocytomas and paragangliomas (PGL). We report here a 75-yo woman with an interaortocaval PGL that was diagnosed after hypertensive crisis occurring during the resection of a kidney tumor. 68Ga-DOTATATE PET-CT disclosed pathologic uptake in the abdomen and at the iliac crest. After the resection of the abdominal tumor, with the histological confirmation of PGL, arterial blood pressure and metanephrine levels normalized. Genetic testing was negative. Thereafter, the bone lesion increased in size and became painful, requiring multiple medications. A selective biopsy disclosed a metastatic lesion arising from the renal tumor. The false positive result of 68Ga-DOTATATE PET-CT is discussed.