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Identification of Distant Metastases From Recurrent Gliosarcoma Using Whole-Body 18F-FDG PET/CT

Unterrainer, Marcus MD, MSc*,†; Ruf, Viktoria MD; Cyran, Clemens C. MD§; Brendel, Matthias MD*; Thon, Niklas MD†,∥; Herms, Jochen MD; Schüller, Ulrich MD¶,**,††; Tonn, Joerg-Christian MD†,∥; Bartenstein, Peter MD*,†; Albert, Nathalie Lisa MD*,†

doi: 10.1097/RLU.0000000000002790
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A 51-year-old man presented with recurrent gliosarcoma and increasing cough over the last months. On 18F-FDG PET/CT, solid lung masses with high 18F-FDG uptake were present. A biopsy taken from a lung lesion indicated distant metastases from gliosarcoma. Gliosarcoma, a rare malignant central nervous system tumor, presents with extracranial metastases in only less than 10%. As highlighted by this case, 18F-FDG PET/CT can be used for whole-body staging in patients with metastatic brain tumor. Vice versa, highly 18F-FDG–avid lung lesions in patients with brain tumors should lead to distant metastases as differential diagnosis despite their rare occurrence.

From the *Department of Nuclear Medicine, University Hospital, LMU Munich, Munich

German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg

Department of Neuropathology and Prion Research

§Department of Radiology, University Hospital

Department of Neurosurgery, University Hospital, LMU Munich, Munich

Institute of Neuropathology

**Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf

††Research Institute Children's Cancer Center Hamburg, Hamburg, Germany.

Received for publication May 23, 2019; revision accepted July 22, 2019.

Conflicts of interest and sources of funding: none declared.

Authors' Contributions: M.U. and N.L.A.: drafting of the manuscript, PET/CT reading, and conceiving the design. V.R., J.H., and U.S.: neuropathological evaluation, increased intellectual content, and revision of the manuscript. C.C.C.: PET/CT and MRI reading, increased intellectual content, and revision of the manuscript. M.B.: PET/CT reading, increased intellectual content, and revision of the manuscript. N.T., J.C.T., and P.B.: clinical management, increased intellectual content, and revision of the manuscript.

Correspondence to: Marcus Unterrainer, MD, MSc, Department of Nuclear Medicine, LMU, Marchioninistr. 15, 81377 Munich, Germany. E-mail: marcus.unterrainer@med.uni-muenchen.de.

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