Discordant 68 Ga-FAPI and 18 F-FDG Uptake in Reactive Lymph Nodes in a Case of Esophageal Cancer and Systemic Lupus Erythematosus.
Azadeh Miralai, Tahereh Ghaedian, Hamideh Sadra et al.
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Case in brief
A 54-year-old woman with systemic lupus erythematosus and distal esophageal squamous cell carcinoma exhibited discordant uptake patterns on 18 F-FDG and 68 Ga-FAPI PET/CT. While 18 F-FDG PET/CT showed diffuse uptake in enlarged axillary lymph nodes, FAPI PET/CT revealed negligible uptake in these nodes but strong uptake in the tumor. Histopathology confirmed reactive hyperplasia in the lymph nodes.
What made this case unusual
The case highlights the discordant uptake patterns between 18 F-FDG and 68 Ga-FAPI PET/CT in a patient with SLE, which is atypical and can mimic lymphoma.
Diagnostic / clinical pearl
Clinicians should be aware that discordant PET/CT uptake patterns in patients with SLE may indicate reactive hyperplasia rather than metastatic disease.
Why it matters
This case emphasizes the potential of FAPI PET/CT to differentiate between inflammatory and metastatic lymph node involvement, which is crucial for accurate diagnosis and management.