Abstract
OBJECTIVES: Neuro endocrine tumors (NETs) demonstrate complex biology where imaging and histology can at times show discordance in a real-world scenario. MATERIALS AND METHODS: We herein present a patient of grade I pancreatic NET showing atypical low somatostatin receptor expression on (68) Ga-DOTATATE PET/CT (positron emission tomography/computed tomography) but intense fluorine-18-deoxyglucose ( (18) FDG) avidity, and when interpreted together, these findings showed discordance with histopathology. RESULTS: The case highlights the crucial role of dual-tracer PET/CT in navigating the tumor biology and landscape of NET and the need for novel strategies to complement traditional histopathology that would enable better therapeutic decision-making.