Unusual Gastric Metastases in the Setting of Recurrence of Pancreatic NET

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.