OBJECTIVE: Prostate specific membrane antigen (PSMA) positron emission tomography diagnostic computed tomography (PET/CT) is gaining an increasing role in the staging of prostate cancer and restaging in cases of biochemical recurrence. Our understanding of PSMA affinity for incidental pathological and non-pathological entities is also maturing although certain cases do present as diagnostic and management dilemmas. SUBJECT AND METHODS: We present a case of a 55 years old man with prostate adenocarcinoma, with incidentally found pancreatic and thyroid lesions showing PSMA avidity. RESULTS: We were able to utilize a heat damaged red blood cell single photon emission tomography (SPET)/CT scan and ultrasound guided fine needle aspiration (FNA) to accurately diagnose co-existent thyroid papillary carcinoma and intra-pancreatic accessory spleen (IPAS) tissue, respectively. The patient avoided invasive pancreatic tissue sampling and subsequent staging with fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT. CONCLUSION: This is the first case to our knowledge describing both such lesions in one patient and the first case describing the use of 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL)-PSMA PET/CT to detect IPAS. Furthermore we highlight the value of nuclear medicine diagnostic work up in complex cases.
OBJECTIVE:Prostate specific membrane antigen (PSMA) positron emission tomography diagnostic computed tomography (PET/CT) is gaining an increasing role in the staging of prostate cancer and restaging in cases of biochemical recurrence. Our understanding of PSMA affinity for incidental pathological and non-pathological entities is also maturing although certain cases do present as diagnostic and management dilemmas. SUBJECT AND METHODS: We present a case of a 55 years old man with prostate adenocarcinoma, with incidentally found pancreatic and thyroid lesions showing PSMA avidity. RESULTS: We were able to utilize a heat damaged red blood cell single photon emission tomography (SPET)/CT scan and ultrasound guided fine needle aspiration (FNA) to accurately diagnose co-existent thyroid papillary carcinoma and intra-pancreatic accessory spleen (IPAS) tissue, respectively. The patient avoided invasive pancreatic tissue sampling and subsequent staging with fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT. CONCLUSION: This is the first case to our knowledge describing both such lesions in one patient and the first case describing the use of 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL)-PSMA PET/CT to detect IPAS. Furthermore we highlight the value of nuclear medicine diagnostic work up in complex cases.
Authors: M J M Uijen; Y H W Derks; W A M van Gemert; J Nagarajah; R I J Merkx; M G M Schilham; J Roosen; B M Privé; S A M van Lith; C M L van Herpen; M Gotthardt; S Heskamp Journal: Eur J Nucl Med Mol Imaging Date: 2021-06-12 Impact factor: 9.236