Case Author(s): J. Philip Moyers, M.D. and Farrokh Dehdashti, M.D. , 12/5/95 . Rating: #D3, #Q3

Diagnosis: Metastatic uterine leiomyosarcoma

Brief history:

Patient is status post hysterectomy


Anterior, posterior and bilateral lateral views from a whole body PET study

View main image(pt) in a separate image viewer

View second image(xr). PA chest radiograph

View third image(ct). Axial Section from chest CT, soft tissue windows

View fourth image(ct). Axial section from chest CT, lung windows

Full history/Diagnosis is available below

Diagnosis: Metastatic uterine leiomyosarcoma

Full history:

40-year old woman with a uterine leiomyosarcoma diagnosed in August 1993, now status post hysterectomy and radiotherapy. Over the last two months, the patient has had cough and daily fever. Computed tomographic examination of the chest after chest radiograph revealed a large right upper hemithorax mass and left lower lobe mass. The right-sided mass was biopsied under CT guidance, revealing metastatic leiomyosarcoma with histologic features similar to the primary tumor. This examination is requested to evaluate extent of metastatic disease prior to debulking surgery due to the patientıs respiratory compromise.


15.8 mCi F-18 fluorodeoxyglucose (FDG) i.v.


Abnormal foci of increased activity are demonstrated in the right upper hemithorax as well as a smaller lesion in the left posterior costophrenic sulcus. Examination of the initial PET images suggests a pleural-based malignancy due to increased activity peripherally and decreased activity centrally. There is increased FDG actvity in the cecum, which is a normal physiologic finding. However, correlative CT examination demonstrates a large amount of necrosis of this metastatic deposit.


Uterine leiomyosarcomas are malignant neoplasms that arise from smooth muscle. These tumors can arise from the walls of small and large blood vessels and can occur anywhere in the body. They also can occur in the viscera, arising from smooth muscle (e.g., the uterus) or from vessels in these organs. Leiomyosarcomas commonly arise in the retroperitoneum, where they are highly aggressive neoplasms. Leiomyosarcomas like other soft tissue sarcomas have poor prognosis and have a tendency to invade aggressively into surrounding tissues and for early hematogenous dissemination, usually to the lungs. Excision biopsy is inadequate as the only therapy and more than 90% of these patients have local recurrences. Surgery alone, surgery combined with radiation, surgery combined with radiation and intraarterial chemotherapy, or radiation alone have been used for treatment. PET imaging with F-18 fluorodeoxyglucose (FDG) has been shown to be useful for assessing solitary pulmonary nodules, mediastinal staging, and assessment of response to therapy on the basis of the differential uptake in non-neoplastic and malignant lesions. However, FDG uptake is not specific for neoplastic lesions as active infection and inflammation such as granulomatous disease can result in increased FDG accumulation.

References: 1) Valk PE et al. Staging non-small cell lung cancer by whole-body positron emission tomographic imaging. Ann Thorac Surg 1995;60:1573-1582. 2) Patz EF et al. Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning. Radiology 1993;188:487-490.

Differential Diagnosis List

Other malignant lung lesions (primary or metastatic) and active infection and inflammation.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Lung, Mediastinum, and Pleura, Category:Neoplasm, Neoplastic-like condition)

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Case number: pt007

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