Interesting Image

Incidental Detection of Sarcomatoid Lung Cancer by [18F] Choline Positron Emission Tomography/Computed Tomography


  • Rensi Marco
  • Decio Capobianco
  • Di Gregorio Fernando
  • Laura Evangelista

Received Date: 06.02.2023 Accepted Date: 05.03.2023 Mol Imaging Radionucl Ther 2023;32(3):250-251 PMID: 37870386

A 79-year-old man treated for prostate cancer (PCa) in 2018 with concurrent hormone therapy and radical radiotherapy (RT) was given metastasis-directed RT because of skeletal progression of PCa in 2021. On [18F]-choline positron emission tomography/computed tomography (CT) for biochemical recurrence (prostate-specific antigen level: 4.96 ng/mL), he showed significant uptake in multiple skeletal lesions and focal uptake in a left lung nodule. CT-guided biopsy revealed a sarcomatoid lung carcinoma. This case confirms that histopathological evaluation is mandatory in the event of significant radiolabeled choline uptake in a single lung nodule.

Keywords: Fluorocholine, cancer, interpretation


Informed Consent: Patient consent was obtained.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: R.M., D.C., Concept: R.M., L.E., Data Collection or Processing: R.M., D.C., Analysis or Interpretation: D.G.F., Literature Search: L.E., Writing: L.E., R.M., D.G.F.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study has received no financial support.


  1. Ferrari M, Renard J, Pereira Mestre R, Bosetti DG, Stoffel F, Treglia G. Change of management by using hybrid imaging with radiolabeled choline in biochemical recurrent prostate cancer: a systematic review and a meta-analysis. Clin Transl Imaging 2021;9:57-71.
  2. Gillebert Q, Huchet V, Rousseau C, Cochet A, Olivier P, Courbon F, Gontier E, Nataf V, Balogova S, Talbot JN; other ICHOROPRO investigators. 18F-fluorocholine PET/CT in patients with occult biochemical recurrence of prostate cancer: Detection rate, impact on management and adequacy of impact. A prospective multicentre study. PLoS One 2018;13:e0191487.
  3. Balogova S, Huchet V, Kerrou K, Nataf V, Gutman F, Antoine M, Ruppert AM, Prignon A, Lavolée A, Montravers F, Mayaud C, Cadranel J, Talbot JN. Detection of bronchioloalveolar cancer by means of PET/CT and 18F-fluorocholine, and comparison with 18F-fluorodeoxyglucose. Nucl Med Commun 2010;31:389-397.
  4. Hara T, Kosaka N, Suzuki T, Kudo K, Niino H. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study. Chest 2003;124:893-901.
  5. Geraldo L, Ceci F, Uprimny C, Kendler D, Virgolini I. Detection of Sarcomatoid Lung Metastasis With 68GA-PSMA PET/CT in a Patient With Prostate Cancer. Clin Nucl Med 2016;41:421-422.
  6. Wu X, Huang Y, Li Y, Wang Q, Wang H, Jiang L. 18F-FDG PET/CT imaging in pulmonary sarcomatoid carcinoma and correlation with clinical and genetic findings. Ann Nucl Med 2019;33:647-656.
  7. Rapicetta C, Lococo F, Stefani A, Rossi G, Ricchetti T, Filice A, Franceschetto A, Treglia G, Paci M. Primary Sarcomatoid Carcinoma of the Lung: Radiometabolic ((18)F-FDG PET/CT) Findings and Correlation with Clinico-Pathological and Survival Results. Lung 2016;194:653-657.
  8. Fuser D, Hedberg ML, Dehner LP, Dehdashti F, Siegel BA. Extensive Metastatic Sarcomatoid Renal Cell Carcinoma Evaluated by 18F-FDG PET/CT: a Case Report and Review of Literature. J Kidney Cancer VHL 2018;5:1-6.