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Aggressive Metastasis With Silent PET/CT: A Lesson From Well-differentiated Splenic Angiosarcoma
Miaomiao Xie1, Hongchao Zhu1, Haiyan Liu2
1Department of Nuclear Medicine.
Clinical Nuclear Medicine
|April 1, 2026
Summary
Primary splenic angiosarcoma, though well-differentiated, can be aggressive. This rare cancer may not show up on dual-tracer PET/CT scans, highlighting the need for careful evaluation.
Area of Science:
- Oncology
- Radiology
- Pathology
Background:
- Primary splenic angiosarcoma is a rare and aggressive cancer.
- It often presents with a poor prognosis.
Purpose of the Study:
- To report a case of well-differentiated splenic angiosarcoma with liver metastases.
- To evaluate the utility of dual-tracer PET/CT imaging (18F-FDG and 68Ga-FAPI) in this case.
Main Methods:
- A 65-year-old woman with pathologically confirmed well-differentiated splenic angiosarcoma was studied.
- Positron Emission Tomography/Computed Tomography (PET/CT) scans using 18F-FDG and 68Ga-FAPI were performed.
Main Results:
- The patient developed liver metastases 5 months after diagnosis.
- Dual-tracer PET/CT imaging showed a "dual-negative" pattern, with no significant radiotracer uptake in the metastatic liver lesions.
- Despite well-differentiated histology, the tumor exhibited rapid progression, indicating aggressive behavior.
Conclusions:
- Well-differentiated splenic angiosarcoma can display aggressive behavior.
- Dual-tracer PET/CT may show negative findings in high-grade splenic angiosarcoma.
- Vigilance and multimodal evaluation are essential for diagnosing such occult malignancies.
