A 57-year-old woman had an incidental finding of a hypervascular small bowel lesion on a contrast-enhanced CT scan performed for a suspected renal graft infection. The morphologic features of the lesion were suggestive of a neuroendocrine tumor (NET), but serum chromogranin A and urinary 5-HIAA were negative. 68Ga-DOTATOC PET/CT showed high SSTR-2 expression in the lesion, suggesting a NET. However, pathologic examination revealed diffuse alpha-smooth muscle actin positivity, consistent with a glomus tumor. This case highlights the utility of PET/CT for in vivo molecular tumor characterization and the challenge of distinguishing between different tumor types with overlapping molecular targets.
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