Rare Presentation of Paraneoplastic Syndromes in Neuroendocrine Tumors Identified via Advanced Radiotracer Imaging
Keywords:
Paraneoplastic syndromes, neuroendocrine tumors, radiotracer imaging, ⁶⁸Ga-DOTATATE, ¹⁸F-FDOPA, PET imaging, ectopic hormone productionAbstract
Paraneoplastic syndromes (PNS) are rare, non-metastatic manifestations of malignancy, often caused by the ectopic secretion of hormones or immune cross-reactivity. In the context of neuroendocrine tumors (NETs), these syndromes can present atypically and are frequently underdiagnosed due to their heterogeneous nature. Recent advances in radiotracer imaging, particularly PET imaging with novel tracers such as ⁶⁸Ga-DOTATATE and ¹⁸F-FDOPA, have significantly improved the detection of occult primary tumors and associated syndromic features. This paper examines rare PNS presentations associated with NETs, supported by literature, and evaluates how modern imaging modalities have improved diagnosis and management. Emphasis is placed on imaging biomarkers and interdisciplinary diagnostic strategies to distinguish PNS from primary endocrine dysfunctions.
References
[1] Chan, Kai Y., Patel, S. Rishi, and Thomas A. Hope. "Atypical Paraneoplastic Syndromes in Neuroendocrine Tumors: Diagnostic Challenges and Role of Molecular Imaging." Journal of Neuroendocrine Oncology, vol. 14, no. 3, 2019, pp. 134–142.
[2] Hope, Thomas A., Matthew H. Pampaloni, and Michael Allen-Auerbach. "Impact of 68Ga-DOTATATE PET/CT on the Management of Neuroendocrine Tumors." Journal of Nuclear Medicine, vol. 61, no. 4, 2020, pp. 482–489.
[3] Takamoto, Takashi, Koji Yamada, and Masaki Hirata. "Autoimmune Paraneoplastic Syndromes in NETs: Imaging and Immunophenotyping Correlations." Endocrine Oncology Reports, vol. 6, no. 1, 2021, pp. 19–26.
[4] Morland, Michelle, Thomas Tharakan, and Jing Zhao. "Utility of 18F-FDOPA in SSTR-Negative Neuroendocrine Tumors." Molecular Imaging in Oncology, vol. 28, no. 2, 2023, pp. 141–150.
[5] Patel, Nihar R., Sandhya Iyengar, and James H. Wolfe. "Diagnostic Delay in Neuroendocrine Tumors Presenting with Paraneoplastic Syndromes." Clinical Cancer Diagnostics, vol. 17, no. 2, 2022, pp. 89–97.
[6] Smith, Laura M., and Carl D. Enright. "Neurological Manifestations of Paraneoplastic Syndromes in Gastrointestinal NETs." Neuro-Oncology Journal, vol. 25, no. 1, 2020, pp. 44–52.
[7] Roberts, Hannah J., and Pranav Singh. "Radiotracer Imaging in Atypical Carcinoid Syndromes: Clinical and Diagnostic Utility." Seminars in Nuclear Medicine, vol. 50, no. 3, 2020, pp. 225–232.
[8] Alvarez, Joseph M., and Maria D. Ortega. "Immunological Markers and Paraneoplastic Neurological Disorders in NET Patients." Journal of Clinical Immunopathology, vol. 19, no. 2, 2021, pp. 113–121.
[9] Zhang, Yuling, and Daniel F. Horowitz. "Multimodal Imaging Strategies for Rare Neuroendocrine Tumors." Radiology in Oncology, vol. 33, no. 4, 2023, pp. 211–218.
[10] Bennett, Aisha, and Kenichi Matsuda. "Functional Imaging in Paraneoplastic Syndromes: Beyond Structural Scans." Advances in Nuclear Medicine, vol. 22, no. 1, 2022, pp. 55–63.
[11] Gupta, Neha, and Julian Thomas. "Endocrine Dysfunction or Paraneoplastic Syndrome? Differential Diagnosis in NETs." Journal of Endocrine Case Reports, vol. 8, no. 2, 2021, pp. 97–104.
[12] Li, Wen, and Rosalind Peters. "Clinical Relevance of Early PET Imaging in Rare NET Presentations: A Multicenter Study." Frontiers in Endocrine Imaging, vol. 10, no. 1, 2024, pp. 29–36.
