High F-18 FDG Uptake in Bone Marrow by Cytokines Secreting Ectopic Mucoepidermoid Carcinoma

A 57-year-old woman, just returned from a bicycling holiday in the mountains, presented with discomfort, hoarseness and chronic cough complaints. After chest x-ray, bronchoscopy and fluoro-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT), a diagnosis of a tumor in the bronchus of the right upper lobe with obstruction pneumonia was made. After lobectomy of the right upper lobe, pathology revealed an ectopic bronchial low-grade mucoepidermoid carcinoma.The diffuse high FDG uptake in the bone marrow standardized uptake value (SUV mean 3.6 and max 5.2) is unlikely to be related to bone marrow stimulation due to pneumonia, but correlates with a high serum level of correlated with transforming growth factor-beta (TGF-beta1) secreted by the low-grade bronchial mucoepidermoid carcinoma.