Triple Tracer Positivity in Metastatic Lymph Nodes from Well-Differentiated Neuroendocrine Tumor in MEN-1 Syndrome.

Patients with multiple endocrine neoplasia type 1 usually have a combination of endocrine disorders due to lesions in the pancreas, parathyroid gland, and pituitary gland. Functional imaging using different tracers in addition to conventional imaging are applied in localizing the primary sites, determining the disease extent, and characterizing the lesions. We present a diagnosed case of multiple endocrine neoplasia type 1 with interesting incidental imaging findings showing 99mTc-sestamibi and 18F-fluorocholine uptake in addition to 68Ga-DOTANOC uptake in metastatic mediastinal and cervical lymph nodes arising from gastroenteropancreatic neuroendocrine tumor. This case shows the possibility of imaging the neuroendocrine tumors with 3 different tracers, namely 68Ga-DOTANOC, 99mTc-sestamibi, and 18F-fluorocholine.