18 F-FDG avid lesion due to coexistent fibrous dysplasia in a child of embryonal rhabdomyosarcoma: Source of false positive FDG-PET

With increasing use of 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the current oncological practice, there is a growing body of evidence of false positive scans due to various benign conditions. In this communication we present intensely avid 18 F-FDG uptake in fibrous dysplasia of right tibia in a 12-year-old child suffering from embryonal rhabdomyosarcoma (ERMS) that could have been easily mistaken to be a metastatic focus if not carefully correlated. The patient was a case of ERMS (presenting with left cervical mass with intrathoracic extension) who was treated successfully with chemotherapy and was referred for FDG-PET to evaluate the disease status. His whole body survey was unremarkable except for an intensely avid FDG uptake (SUV max 8.5) in shaft of right tibia. The scan was extended up to foot in view of the fact that a prior bone scan had shown a focal uptake in the similar location. Efforts were undertaken to elucidate the exact etiopathology of the aforementioned 18 F-FDG uptake because the rest of the whole body survey was unremarkable. A plain radiograph (both anteroposterior and lateral views) of the right tibia showed patchy sclerosis involving the middle diaphysis of the right tibia suggesting a fibrous defect. The computed tomography (CT) scan of the same region showed cortical thickening and increased density within the medullary cavity in the shaft of the tibia. A histopathological diagnosis was sought for and the lesion was subsequently proven to be fibrous dysplasia by histopathology of the bone piece obtained from the right tibial lesion by J needle biopsy. The present case is a useful addition to the current body of literature of false positive 18 F-FDG-PET study due to a benign skeletal pathology and underscores the importance of high index of suspicion and careful clinicoradiopathologic correlation, whenever one comes across such an unusual PET finding.