Aggressive Metastasis With Silent PET/CT

Primary splenic angiosarcoma is a rare, aggressive malignancy carrying a poor prognosis. A 65-year-old woman with a pathologically confirmed well-differentiated splenic angiosarcoma developed liver metastases 5 months into follow-up. Subsequent 18F-FDG and 68Ga-FAPI PET/CT imaging revealed a "dual-negative" pattern, demonstrating no significant radiotracer uptake in the metastatic liver lesions. Despite well-differentiated histology, the tumor showed rapid progression, confirming aggressive behavior in well-differentiated angiosarcoma. The high-grade splenic angiosarcoma demonstrated negative findings on dual-tracer PET/CT, underscoring that vigilance and comprehensive multimodal evaluation are crucial for such occult malignancies.