The incidetal detection of a sarcomatoid lung cancer by [18f] choline positron emission tomography/computed tomography

A 79-year old man, treated for prostate cancer (PCa) in 2018 with concurrent hormone therapy and radical radiotherapy (RT), was given metastasis-directed RT due to a skeletal progression of PCa in 2021. On [18F]-choline PET/CT for a biochemical recurrence (prostate-specific antigen level: 4.96 ng/mL), he showed a significant uptake in multiple skeletal lesions and a focal uptake in a left lung nodule. CT-guided biopsy revealed a sarcomatoid lung carcinoma. This case confirms that histopathological evaluation is mandatory in the event of a significant radiolabeled choline uptake in a single lung nodule.