• Akane Ariga, Seiichi Matsumoto, Taisuke Tanizawa, Keiko Hayakawa, Yusuke Minami, Masanori Saito, Norio Kurosawa, Kyoko Yamashita, Takashi Terauchi, and Keisuke Ae.
• Department of Orthopedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
• Medicine (Baltimore). 2023 Jul 14; 102 (28): e34196e34196.

RationaleFluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is considered a reliable and indispensable imaging method when evaluating distant metastases and clinical staging of angiosarcomas. Here, we report 2 cases of angiosarcoma with bone metastases with "false negative" findings on 18F-FDG PET/CT.Patient ConcernsCase 1, a 39-year-old woman, who had undergone mastectomy for primary angiosarcoma 2 years prior, presented with a 5-month history of right coxalgia. Case 2 was a 37-year-old woman, who had undergone mastectomy for primary angiosarcoma 4 months prior. During postoperative follow-up, multiple bone lesions were detected on magnetic resonance imaging (MRI).DiagnosesBased on the histopathological findings, both cases were diagnosed with bone metastases of angiosarcoma. Although MRI showed multiple bone metastatic lesions, 18F-FDG PET/CT showed no uptake or osteolytic destruction in both cases.InterventionsWeekly paclitaxel was initiated as a salvage chemotherapy in both cases.OutcomesNo uptake or osteolytic lesions were observed on 18F-FDG PET/CT, despite multiple bone metastases detected on MRI.LessonsFalse-negative findings on 18F-FDG PET/CT should be considered when evaluating bone metastases of angiosarcoma. Even with negative findings on 18F-FDG PET/CT, open biopsy should be performed if MRI indicates bone metastases.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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