High-Grade Hepatic Spindle Cell Carcinoma as a Cause of Diffuse Right Hepatic Lobe Hypermetabolism Identified With 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) Imaging.

We present a rare case of high-grade spindle cell liver carcinoma investigated using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in a 70-year-old man with worsened clinical symptoms for more than three months. These include hiccups, belching, loss of appetite, and significant weight loss of 30 kg over the last three months. 18F-FDG PET/CT was employed as part of the initial diagnostic assessment, revealing intense diffuse right hepatic lobe hypermetabolism. Fused PET/CT images revealed a locally confined right hepatic lobe tumor exhibiting heterogeneous metabolic activity with predominant hypermetabolism surrounding two internally contained hypometabolic islands. These findings suggested an aggressive and unusual neoplastic pattern. Ultrasound-guided biopsy confirmed high-grade spindle cell sarcoma of the liver. Unfortunately, the patient passed away shortly thereafter, precluding therapeutic decisions.