A 69-year-old woman with nasopharyngeal cancer was referred to PET/CT in order to detect a suspected local recurrence. FDG PET/CT images demonstrated increased FDG uptake at the left nasopharyngeal region suggestive of locally recurrent tumor (Fig. 4). Also, there were multiple bone and bone marrow involvement at the vertebral column and manubrium sterni. Bone marrow biopsy proved sinonasal tumor involvement despite a thrombocyte count of 180,000 per µL.