Discovery of a Small Primary Tumor on the Appendix Tip in a Patient with Liver Neuroendocrine Metastases via Ga-68 DOTA-TATE PET/CT Images

Carcinoid tumors of the appendix most commonly occur between the 3rd and 4th decades. Clinically, these can present as acute appendicitis, but sometimes, the patients may not present with pain if the tumor is at the appendix tip as it may not cause luminal obstruction. Patients with a tumor diameter of <1–2 cm have a very low risk for widespread disease (1, 2). The most significant adverse prognostic factor is the presence of liver metastases (3, 4). Experience related to advanced disease is lacking because of the rare occurrence of these tumors. In metastatic appendiceal tumors, instead of only appendectomy, more aggressive surgeries such as right hemicolectomy are recommended (3, 5). Although Ga-68 DOTA-TATE PET/CT has a significant clinical impact in the management of patients with NET, till date, no case report has been presented related to the imaging features and somatostatin receptor expression status in an appendiceal carcinoid as small as 10 mm. Consequently, this case shows us that a small appendecial tumor can have an aggressive nature regardless of the tumor size and careful examination should be performed to reveal the primary focus (Figure 1a-c).