# “Not All That Glitters Is Gold”: Paraspinal Cavernous Hemangioma Mimicking Paraganglioma on Somatostatin Receptor PET/CT

## TL;DR

A case study shows how a paraspinal cavernous hemangioma can look like a paraganglioma on PET/CT scans, leading to a false positive diagnosis.

## Contribution

This case highlights the potential for false positives in SSTR PET/CT due to endothelial SSTR overexpression in hemangiomas.

## Key findings

- A paraspinal cavernous hemangioma mimicked a paraganglioma on SSTR-PET/CT imaging.
- Strong endothelial SSTR expression was confirmed via immunohistochemistry.
- False positives in SSTR-PET/CT may occur due to SSTR overexpression in non-neuroendocrine lesions.

## Abstract

We report the case of a 77-year-old male with a paraspinal mass at the Th11 level. Given its morphology and location, CT and MRI findings raised the suspicion of paraganglioma. A somatostatin receptor positron emission tomography/contrast-enhanced-CT (SSTR-PET/CE-CT) scan with Gallium-68 DOTATATE, performed for staging of suspected paraganglioma, demonstrated intense tracer uptake in the lesion, reinforcing the suspicion of a neuroendocrine tumor with increased SSTR expression. However, histopathology demonstrated a cavernous hemangioma with partial sclerosis, and immunohistochemistry showed strong endothelial SSTR expression. This case highlights the possibility of false-positive findings on SSTR PET/CT, as a cavernous hemangioma may closely mimic paraspinal paraganglioma in both imaging appearance and tracer uptake pattern. Notably, the intense tracer accumulation in this case was not solely related to the lesion’s hypervascularity but predominantly to the marked endothelial overexpression of SSTR demonstrated on immunohistochemistry.