What question did this study set out to answer?

To highlight the occurrence of solitary humeral metastasis in a child with no detectable primary neuroblastoma.

March 4, 2026

Solitary Humeral Metastasis in the Absence of Detectable Primary Neuroblastoma on Triple-tracer Imaging With 18F-FDG, 123I-MIBG, and 68Ga-DOTATATE

SLSiqi LiTongji University CLCinian LvLaboratoire d’Imagerie Biomédicale PXPeng XieHebei Medical University

Key Points

To highlight the occurrence of solitary humeral metastasis in a child with no detectable primary neuroblastoma.
Conducted 18F-FDG PET/CT to detect tumor source.
Performed bone marrow biopsy to confirm neuroblastoma metastasis.
Utilized 123I-MIBG and 68Ga-DOTATATE scans for further evaluation.
Detected solitary metastatic neuroblastoma in the left humerus.
Primary tumor remained undetectable despite advanced imaging.
Comprehensive imaging failed to identify the origin of metastasis.

Abstract

A 6-year-old boy presented with a 2-month history of fever of unknown origin. 18 F-FDG PET/CT was performed to identify the potential source, revealing a solitary focus of abnormal radiotracer uptake in the left humerus. Bone marrow biopsy confirmed metastatic neuroblastoma. Subsequent 123 I-MIBG SPECT/CT and 68 Ga-DOTATATE PET/CT scans failed to detect a primary tumor site. This case illustrates that solitary humeral metastasis can occur in the absence of an identifiable primary neuroblastoma, even after comprehensive imaging with 3 different radiotracers: 18 F-FDG, 123 I-MIBG, and 68 Ga-DOTATATE.

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