Multiple Bone Involvement in Low-grade Myofibroblastic Sarcoma Demonstrated on ¹⁸F-FDG PET/CT

A 68-year-old woman with low back pain for 2 months was admitted. T2-weighted fat-saturated imaging revealed hyperintense lesions in multiple lumbar regions, suggesting the possibility of bone metastases. Multiple osteolytic and mixed osteolytic-osteoblastic lesions with significant ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake, as well as multiple osteoblastic lesions with mild ¹⁸F-FDG uptake, were observed on subsequent ¹⁸F-FDG positron emission tomography/computed tomography without an identifiable primary lesion. This patient was pathologically diagnosed with low-grade myofibroblastic sarcoma (LGMS) after biopsy and surgery. Although multiple bone involvement in LGMS is extremely rare, this case suggests that it should be considered in the differential diagnosis of multiple bone metastases.