Triple Tracer Heterogeneity in Dual Neoplasia: The "Three Musketeers" in Discerning Squamous Cell Carcinoma and Paraganglioma in the Same Patient

Authors

• Shyam Kumar Ravada
• Gaurav Malhotra
• Aaditya Daga
• Anurag R Lila
• Saba Memon
• Tushar Bandgar

Language

English

Publication Date

6-1-2026

Journal

Clinical Nuclear Medicine

DOI

10.1097/RLU.0000000000006149

PMID

41129749

PMCID

PMC13132081

PubMedCentral® Posted Date

10-2-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Head and neck squamous cell carcinoma of unknown primary (HNSCCUP) comprises 2%-5% of head and neck squamous cell cancers (HNSCC). Its coexistence with abdominal paraganglioma is exceedingly rare. We report a unique case of a 48-year-old male with HNSCCUP presenting as cervical lymphadenopathy and a coexisting abdominal paraganglioma. 18 F-FDG showed uptake in both lesions, while 68 Ga-DOTATATE was avid only in paraganglioma, and 68 Ga-DOTA-FAPI-04 was avid only in cervical nodes. These differential uptake patterns reflect distinct tumor biology and underscore the potential for tailoring theranostic treatment strategies with 177 Lu/ 90 Y isotopes for FAPI-avid squamous cell cancers (SCC) and DOTATATE-avid paragangliomas.

Keywords

Humans, Male, Middle Aged, Paraganglioma, Carcinoma, Squamous Cell, Radioactive Tracers, Head and Neck Neoplasms, Organometallic Compounds, head and neck squamous cell carcinoma of unknown primary (HNSCCUP), paraganglioma, 68Ga-DOTATATE PET/CT, 68Ga-DOTA-FAPI-04 PET/CT, 18F-FDG PET/CT, theranostics

Published Open-Access

yes

Recommended Citation

Ravada, Shyam Kumar; Malhotra, Gaurav; Daga, Aaditya; et al., "Triple Tracer Heterogeneity in Dual Neoplasia: The "Three Musketeers" in Discerning Squamous Cell Carcinoma and Paraganglioma in the Same Patient" (2026). Faculty, Staff and Student Publications. 4423.
https://digitalcommons.library.tmc.edu/uthmed_docs/4423