# A Rare Case of Neuroendocrine Tumor Presenting as Isolated Scalp Swelling With Paroxysmal Symptoms

## TL;DR

A rare case of a neuroendocrine tumor in the scalp with unusual symptoms is reported, highlighting diagnostic challenges and potential risks during procedures.

## Contribution

This is the first reported case of an isolated scalp neuroendocrine tumor without an identifiable primary source.

## Key findings

- Histopathology confirmed a grade 2 neuroendocrine tumor with a Ki-67 index of 8-10%.
- 68Ga-DOTANOC PET-CT found no evidence of residual, recurrent, or primary somatostatin receptor-expressing disease.
- The patient experienced syncope post-FNAC, suggesting a carcinoid-like crisis from lesion manipulation.

## Abstract

We report a 36-year-old male with a nine-year history of recurrent left frontal scalp swelling following minor trauma, associated with local warmth, sweating, and a syncopal episode during fine-needle aspiration cytology (FNAC). Histopathology confirmed grade 2 neuroendocrine tumor (NET) with a Ki-67 index of 8-10%. 68Ga-DOTANOC positron emission tomography and computed tomography (PET-CT) showed no evidence of residual, recurrent, or primary somatostatin receptor-expressing disease, confirming this as a rare case of isolated scalp NET without an identifiable primary source. This is, to our knowledge, the first reported case of its kind. The patient’s syncope post-FNAC highlights the risk of carcinoid-like crisis from lesion manipulation. This case underscores the importance of a high index of suspicion, thorough immunohistochemical workup, and consideration of peri-procedural octreotide prophylaxis.