PET/CT Detection of Epstein-Barr Virus-Positive Lacrimal Sac Carcinoma in Unknown Primary Cervical Nodal Metastasis.

Hao, Lu; Luo, Baihua; Long, Tingting; Hu, Shuo · Clin Nucl Med · 2026

case_report · Level V

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Abstract

A 55-year-old man presented with a left submandibular mass. Biopsy revealed metastatic carcinoma, later confirmed by immunohistochemistry as Epstein-Barr virus (EBV)-positive nonkeratinizing squamous cell carcinoma, possibly of nasopharyngeal or pulmonary origin. Despite elevated serum EBV-DNA (79.1 copies/mL), nasopharyngeal endoscopy and biopsies were normal. 18 F-FDG PET/CT revealed an FDG-avid nodule in the left lacrimal sac and hypermetabolic cervical nodes. Surgical resection confirmed EBV-encoded RNA (EBER)-positive undifferentiated carcinoma in the lacrimal sac and metastasis in lymph nodes. This case highlights the lacrimal sac as a rare primary site of EBV-associated carcinoma and the utility of 18 F-FDG PET/CT in detecting occult primaries.

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