18FDG PET/CT in pulmonary carcinosarcoma and brain metastasis

Document Type : Case report


1 Nuclear Medicine Research Center,Mashhad University of Medical Sciences, Mashhad, Iran

2 Nuclear Medicine &amp, Molecular Imaging Department, Imam Reza International University, Razavi Hospital, Mashhad, Iran


 Carcinosarcoma is a rare type of cancer that is composed of a mixture of sarcomatous and carcinomatous elements. Pulmonary carcinosarcoma has a 25% five-year survival rate with a prognosis poorer than other non-small cell lung carcinomas. Herein, we report a case of pulmonary carcinosarcoma and its 18F-FDG PET/CT findings. A 61-year-old male patient presented with brain symptoms, including headache, nausea, right hemiplegia, and few attacks of seizures. He underwent brain computed tomography (CT) scan showing a brain lesion in the left parietal lobe. The patient underwent excisional biopsy, and brain lesion was removed. The results of tissue sampling were indicative of carcinosarcoma. Based on anatomical imaging and evidence of pulmonary lesion, the patient underwent 18FDG PET/CT that revealed a heterogeneous mass on the upper lobe of the left lung. An intense FDG uptake was observed along the rim of the mass; however, no FDG uptake was observed in the center of the mass. There were multiple mediastinal lymph nodes with a high FDG uptake. Pulmonary carcinosarcoma was confirmed by tissue sampling.


Main Subjects

  1. Yamazaki K. A. A gastric carcinosarcoma with neuroendocrine cell differentiation and undifferentiated spindle-shaped sarcoma component possibly progressing from the conventional tubular adenocarcinoma; an immunohistochemical and ultrastructural study Virchows Arch. 2003 Jan;442(1):77-81.
  2. Li B, Zhang Y, Hou J, Yu H, Shi H. Primary Liver Carcinosarcoma and 18F-FDG PET/CT. Clin Nucl Med. 2016 Aug;41(8):e383-5.
  3. Braham E, Ben Rejeb H, Aouadi S, Kilani T, El Mezni F. Pulmonary carcinosarcoma with heterologous component: report of two cases with literature review. Ann Transl Med. 2014 Apr;2(4):41
  4. Sakane T, Okuda K, Hattori H, Watanabe T, Oda R, Tatematsu T, Yokota K, Haneda H, Inagaki H, Nakanishi R. Blastomatoid pulmonary carcinosarcoma: A rare case report and review of the literature. Thorac Cancer. 2018 Oct;9(10):1323-1326
  5. Borczuk AC.Uncommon Types of Lung Carcinoma With Mixed Histology: Sarcomatoid Carcinoma, Adenosquamous Carcinoma, and Mucoepidermoid Carcinoma. Arch Pathol Lab Med. 2018 Aug; 142(8):914-921
  6. Ciarallo A, Makis W, Novales-Diaz JA, Lisbona R. Sarcomatoid carcinoma (carcinosarcoma) of the lung mimics malignant pleural mesothelioma on 18F-FDG PET/CT: a report of 2 cases. Clin Nucl Med. 2012 Apr;37(4):416-9.
  7. Li B, Zhang Y, Hou J, Cai L, Zhou J, Shi H. Gastric Carcinosarcoma and 18F-FDG PET/CT. Clin Nucl Med. 2015 Nov;40(11):e506-7.
  8. Sato Y, Shimozono T, Kawano S, Toyoda K, Onoe K, Asada Y, Hayashi T. Gastric carcinosarcoma, coexistence of adenosquamous carcinoma and rhabdomyosarcoma: a case report. Histopathology. 2001 Nov;39(5):543-4.
  9. Mine T, Mizukami M, Tomita T, Iri H, Mihara H. Case of lung carcinosarcoma with brain metastasis. No To Shinkei. 1969 Jul;21(7):805-10.
  10. Kanehisa Y, Kaji M. A case of pulmonary carcinosarcoma presenting cerebellar metastasis. Rinsho Shinkeigaku. 1993 Nov;33(11):1170-4.
  11. Oliveira MF, Watanabe SC, Andrade MP, Rotta JM, Pinto FC. Sarcomatoid carcinoma of the lung with brain metastases. J Bras Pneumol. 2013 Nov- Dec;39(6):753-6.
  12. Al-Zaghal A, Raynor WY, Seraj SM, Werner TJ, Alavi A. FDG-ET imaging to detect and characterize underlying causes of fever of unknown origin: an unavoidable path for the foreseeable future. Eur J Nucl Med Mol Imaging. 2019 Jan;46(1):2-7.
  13. Ho KC, Toh CH, Li SH, Liu CY, Yang CT, Lu YJ, Su TP, Wang CW, Yen TC. Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lungadenocarcinoma and brain metastases. Eur J Nucl Med Mol Imaging. 2018 Nov 10.[Epub ahead of print].
  14. Yamamoto AJ, Zhuang H, Alavi A.Detection of cranial metastases by F-18FDG positron emission tomography. Clin Nucl Med. 2001 May;26(5):402-4.
  15. Coleman RE. PET in lung cancer staging. Q J Nucl Med. 2001 Sep;45(3):231-4