Unusual Gastric Metastases in the Setting of Recurrence of Pancreatic NET: Dual Tracer PET/CT and Theranostic Approach.

Gastric metastases from neuroendocrine tumors (NET) are infrequently encountered. Commonly, locally advanced pancreatic NET can involve stomach resulting in inoperable presentation. We herein present a case of gastric wall metastatic disease in postoperative pancreatic NET, which was identified on [68Ga]Ga-DOTATATE-PET/CT as recurrence of disease after prolong progression-free period. [18F]F-FDG avidity of the lesions on [18F]F-FDG-PET/CT indicated requirement of chemotherapy alone, or in combination with [177Lu]Lu-DOTATATE peptide receptor radionuclide therapy (PRRT). Hence, dual-tracer PET/CT imaging proved important in identifying unusual metastatic disease site and deciding therapeutic strategies in GEP-NET after a long follow-up period following surgical removal of primary disease.