We report a case of a 73-year-old man with minimally invasive lung adenocarcinoma, post-resection, evaluated with ¹⁸F-FDG PET/CT for suspected disease progression. Imaging showed increased FDG uptake in the right lower lung mass and systemic lymphadenopathy (mediastinal, supraclavicular, axillary, paraaortic, and iliac regions). The appearance of a stable lymph node and a clinical history of IgG4 lymphadenopathy suggested an inflammatory process, although malignancy in the lung mass and mediastinal nodes could not be excluded. Lobectomy confirmed the presence of lung adenocarcinoma, while radical lymph node dissection identified IgG4-related lymphadenopathy without metastasis. This case underscores the need for considering differential diagnosis of PET-positive lymphadenopathy, especially in patients with comorbid conditions that mimic or coexist with malignancy.

A 50-year-old woman presented a rapidly proliferative cystic lesion in the left pelvis as displayed by sonography. Exploratory laparoscopy with omental biopsy suggested pseudomyxoma peritonei (PMP). An ¹⁸F-FDG PET/CT revealed scalloping of the liver surface with an associated extrahepatic lesion exhibiting moderate FDG avidity and strand-like FDG uptake within a left-sided septated ovarian cyst. The diagnosis of low-grade appendiceal mucinous neoplasms was proven after cytoreductive surgery. This case provided important imaging features on ¹⁸F-FDG PET/CT that directed the pre-operative diagnosis and the initiation of treatment.