What question did this study set out to answer?

To analyze the unusual presentation of metastatic neuroblastoma in adults without a detectable primary tumor.

April 8, 2026

Abnormal 18F-FDG and 18F-MFBG Uptake in the Skeletal System of an Adult Patient With Neuroblastoma in the Absence of a Detectable Primary Tumor

Key Points

To analyze the unusual presentation of metastatic neuroblastoma in adults without a detectable primary tumor.
Patient evaluation for recurrent fever and pancytopenia.
Use of 18F-FDG PET/CT for initial assessment of skeletal involvement.
Histopathologic confirmation via bone marrow biopsy.
Post-treatment assessment using 18F-MFBG PET/CT.
Initial imaging revealed diffuse skeletal involvement consistent with metastatic disease.
Histopathological analysis confirmed neuroblastoma diagnosis.
No primary tumor site was identified in both imaging studies.
Subsequent imaging demonstrated multiple skeletal metastases.

Abstract

A 30-year-old woman was evaluated for recurrent fever and pancytopenia. 18F-FDG PET/CT revealed diffuse skeletal involvement, consistent with disseminated metastatic disease. Histopathologic analysis of a bone marrow biopsy confirmed the diagnosis of neuroblastoma. The patient subsequently received neuroblastoma-targeted chemotherapy. Following treatment, she participated in a clinical trial and underwent an 18F-MFBG PET/CT examination, which demonstrated multiple skeletal metastases. Notably, neither imaging modality identified a primary tumor site. This case illustrates that metastatic neuroblastoma in adults may present with extensive osseous involvement in the absence of a detectable primary tumor, even after comprehensive functional imaging with both 18F-FDG and 18F-MFBG.

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