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Fig. 1A. —52-year-old woman with aggressive systemic mastocytosis with splenomegaly; biopsy-proven mast cell infiltration of liver; and multiple skeletal mast cell infiltration of pelvis, both femora, spine, ribs, and scapulae. One day before positron emission tomography (PET), pathologic fracture of right femoral neck was diagnosed, leading to right-sided hip replacement 5 days after PET. Histology of femoral head revealed 50% bone marrow infiltration. In this patient, aggressive systemic mastocytosis was associated with chronic myelomonocytic leukemia. Coronal maximum-intensity-projection FDG PET image shows no signs of infiltration in known lesions. However, moderate radiotracer accumulation was present in both proximal humeri (arrows) that was also seen in two other patients and did not show any correlation with other imaging methods.

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