A Rare Case of Triple Primary Malignant Neoplasms (RCC and Colon Cancer) Detected by 18F-FDG PET/CT

Sep 23, 2026

Uploaded by Aria

Multiple primary malignancies can occur in routine oncology, but they require careful early detection and treatment planning. A 73-year-old man with sigmoid adenocarcinoma underwent initial staging with 18F-fluorodeoxyglucose PET/CT. The scan identified two metabolically active lesions in the sigmoid and ascending colon, and a large heterogeneous renal mass with increased 18F-FDG uptake in soft tissue components. Additional 18F-FDG-positive lytic bone lesions, small lung nodules, and mildly active mediastinal/hilar lymph nodes suggested synchronous neoplasms with secondary foci, prompting histological evaluation.

LanguageEnglish

CategoryHealthcare

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Abstract

Case presentation and imaging findings

Histological evaluation

A Rare Case of Triple Primary Malignant Neoplasms (RCC and Colon Cancer) Detected by 18 F-FDG PET/CT 18F-FDG PET/BT ile Tespit Edilen Nadir Bir Üçlü Primer Malign Neoplazm (RCC ve Kolon Kanseri) Olgusu Petya Nikolova, Valeria Hadzhiyska, Yavor Gramatikov, Stefani Veneva, Georgi Gaydarov, Elena Raycheva, Mihaela Ilcheva Alexandrovska University Hospital, Department of Nuclear Medicine, Sofia, Bulgaria Abstract Multiple primary malignancies are not uncommon in daily oncology practice, even though their frequency in the same or different organ systems varies. Regardless, early detection and proper planning of therapeutic approaches are essential for successful management. Here, we present a 73-years-old male with adenocarcinoma of the sigmoid who was referred for initial staging with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) . 18F-FDG PET/CT revealed two metabolically active formations in the sigmoid and ascending colon and a large, heterogeneous tumor lesion in the middle and lower third of the left kidney, with increased 18F-FDG uptake in soft tissue components, suggesting the presence of synchronous neoplasms. The scan also showed 18F-FDG-positive multiple metabolically active lytic bone lesions with soft tissue components, small pulmonary nodules, and mediastinal/hilar lymph nodes with mildly elevated metabolic activity, suggesting secondary foci. Considering these findings, the patient was referred for histological evaluation. Keywords: 18F-FDG PET/CT, synchronous tumors, colon cancer, renal cell carcinoma Öz Çoklu primer maligniteler, aynı veya farklı organ sistemlerinde görülme sıklıkları farklılık gösterse de, günlük onkoloji pratiğinde nadir görülen bir durum değildir. Ne olursa olsun, başarılı bir yönetim için erken teşhis ve terapötik yaklaşımların uygun şekilde planlanması önemlidir. Burada, 18F-florodeoksiglukoz (18F-FDG) pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/BT) ile ilk evreleme için yönlendirilen, sigmoidadenokarsinomlu 73 yaşında bir erkek hastayı sunuyoruz. 18F-FDG PET/BT, yumuşak doku bileşenlerinde artan 18F-FDG alımı ile senkronize neoplazmların varlığını düşündüren, sigmoid ve çıkan kolonlarda metabolik olarak aktif iki oluşumu ve sol böbreğin orta ve alt üçte birlik kısmındabüyük, heterojen bir tümöral lezyonu ortaya çıkardı . Taramada ayrıca ikincil odakları düşündüren, yumuşak doku bileşenleri içeren 18F-FDG-pozitif çoklu metabolik olarak aktif litik kemik lezyonları, küçük pulmoner nodüller ve hafif derecede yüksek metabolik aktiviteye sahip mediastinal/hilerlenf düğümleri görüldü . Bu bulgular dikkate alınarak hasta histolojik değerlendirmeye yönlendirildi. Anahtar kelimeler: 18F-FDG PET/BT, senkron tümörler, kolon kanseri, renal hücreli karsinom Address for Correspondence: Petya Nikolova MD, Alexandrovska University Hospital, Department of Nuclear Medicine, Sofia, Bulgaria E-mail: petia. nn@abv. bg ORCID ID: [orcid.org/0000-0001-9200-3708](orcid.org/0000-0001-9200-3708) [Received:](Received: 13.02.2024 Accepted: 14.05.2024 Publication Date: 07.02.2025)[ 13.02.2024](Received: 13.02.2024 Accepted: 14.05.2024 Publication Date: 07.02.2025)[ Accepted:](Received: 13.02.2024 Accepted: 14.05.2024 Publication Date: 07.02.2025)[ 14.05.2024](Received: 13.02.2024 Accepted: 14.05.2024 Publication Date: 07.02.2025)[ Publication Date:](Received: 13.02.2024 Accepted: 14.05.2024 Publication Date: 07.02.2025)[ 07.02.2025](Received: 13.02.2024 Accepted: 14.05.2024 Publication Date: 07.02.2025) Cite this article as: Nikolova P, Hadzhiyska V, Gramatikov Y, Veneva S, Gaydarov G, Raycheva G, Ilcheva M. A rare case of triple primary malignant neoplasms (RCC and colon cancer) detected by 18F-FDG PET/CT. Mol Imaging Radionucl Ther. 2025;34:55-57 . Copyright© 2025 The Author. Published by Galenos Publishing House on behalf of the Turkish Society of Nuclear Medicine. This is an open access article under the Creative Commons Attributi

FAQs

What patient and primary diagnosis were presented in the case?

A 73-year-old male with adenocarcinoma of the sigmoid colon was referred for initial staging.

What did 18F-FDG PET/CT show in this patient?

PET/CT revealed metabolically active lesions in the sigmoid and ascending colon, a large heterogeneous left kidney tumor, 18F-FDG-positive lytic bone lesions, small pulmonary nodules, and mildly active mediastinal/hilar lymph nodes.

Why was the patient referred for histological evaluation?

Because the imaging findings suggested synchronous neoplasms with possible secondary foci, requiring confirmation by histology.

Sep 23, 2026

Uploaded by Aria