ABSTRACT
ABSTRACT: A 51-year-old man with newly diagnosed small cell neuroendocrine carcinoma of the prostate was referred for a staging 18 F-DCFPyL PET/CT, which showed a solitary metastasis in the left acetabulum. Subsequent 18 F-FDG PET/CT showed intense uptake throughout the prostate as well as extensive avid pelvic and thoracic nodal disease and redemonstration of the left acetabular metastasis. Despite initial metabolic response to treatment, subsequent 18 F-FDG PET 8 months later revealed significant progression of nodal disease above and below the diaphragm, as well as multiple new sites of metastases.
Subject(s)
Carcinoma, Neuroendocrine , Carcinoma, Small Cell , Male , Humans , Middle Aged , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Prostate , Positron-Emission Tomography , Carcinoma, Small Cell/diagnostic imaging , Carcinoma, Neuroendocrine/diagnostic imagingABSTRACT
ABSTRACT: An 83-year-old man was referred for an 18 F-DCFPyL PET scan for the evaluation of rising serum prostate-specific antigen level on the background of previous radical prostatectomy for prostate adenocarcinoma and urinary outflow tract obstruction requiring in-dwelling catheter insertion. The PET scan demonstrated focal increased activity (SUV max , 35.7) at the dorsal aspect of the mid penile shaft, with histopathological confirmation of penile metastasis from primary prostate cancer.
Subject(s)
Carcinoma , Penile Neoplasms , Prostatic Neoplasms , Male , Humans , Aged, 80 and over , Positron Emission Tomography Computed Tomography/methods , Prostate/pathology , Lysine , Urea , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Penile Neoplasms/diagnostic imagingABSTRACT
ABSTRACT: A 64-year-old man with recently diagnosed prostate adenocarcinoma and Gleason score 4 + 3 = 7 with a mildly elevated prostate-specific antigen of 5.17 µg/L was referred for 18 F-DCFPyL PET/CT for primary staging. The scan demonstrated incidental innumerable moderately avid subcutaneous nodules due to adiposis dolorosa (Dercum's disease), which is a rare adipose tissue disease.
Subject(s)
Adiposis Dolorosa , Male , Humans , Middle Aged , Adiposis Dolorosa/diagnosis , Positron Emission Tomography Computed TomographySubject(s)
Carcinoma/diagnostic imaging , Carcinoma/secondary , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Yttrium Radioisotopes , Carcinoma/metabolism , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/metabolism , Female , Humans , Liver Neoplasms/metabolism , Middle Aged , Subtraction Technique , Yttrium Radioisotopes/pharmacokineticsABSTRACT
Tumor-induced osteomalacia is typically caused by benign mesenchymal tumors of vascular or skeletal origin. Overexpression of fibroblast growth factor 23 (FGF-23) by these tumors is associated with decreased resorption of phosphate in the renal tubules. This phosphate wasting leads to the characteristic findings of hypophosphatemia and hyperphosphaturia. Chronic hypophosphatemia causes abnormal mineralization of bone, increased alkaline phosphatase and, in the longer term, osteomalacia. Localization and resection of the FGF-23-secreting tumor offers the best chance of cure. We report a case of a 74-year-old woman diagnosed with numerous fractures on bone scintigraphy. Bone biopsy confirmed osteomalacia. Biochemical investigations showed hypophosphatemia, hyperphosphaturia, and increased alkaline phosphatase, suggesting the presence of an FGF-23-secreting tumor. Biochemistry also showed hyperparathyroidism and subclinical hyperthyroidism. Thyroid and parathyroid scintigraphy were performed and showed separate areas of focally increased tracer uptake in the neck. The patient underwent octreotide scintigraphy to localize an alternative site of tumor. This showed focally increased tracer uptake in the neck and in the abdomen. The patient underwent a hemithyroidectomy, parathyroidectomy, and adrenalectomy. Histopathology showed a papillary carcinoma of the thyroid, a parathyroid adenoma, and an adrenal adenoma. Postoperatively the patient showed rapid symptomatic and biochemical improvement.
Subject(s)
Fractures, Bone/diagnosis , Fractures, Spontaneous/diagnosis , Neoplasms, Multiple Primary/complications , Neoplasms, Multiple Primary/diagnosis , Octreotide , Osteomalacia/diagnosis , Osteomalacia/etiology , Aged , Diagnosis, Differential , Female , Fibroblast Growth Factor-23 , Fractures, Bone/etiology , Fractures, Spontaneous/etiology , Humans , Radiopharmaceuticals , Whole Body ImagingSubject(s)
Cerebrospinal Fluid , Intracranial Hypotension/diagnosis , Subdural Effusion/diagnosis , Aged , Contrast Media , Diagnosis, Differential , Female , Gadolinium DTPA , Humans , Intracranial Hypotension/physiopathology , Magnetic Resonance Imaging , Radiopharmaceuticals , Subdural Effusion/physiopathology , Thoracic Vertebrae , Tomography, Emission-Computed , Tomography, X-Ray ComputedSubject(s)
Low Back Pain/diagnosis , Low Back Pain/etiology , Sarcoma/complications , Sarcoma/diagnostic imaging , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/diagnostic imaging , Technetium Tc 99m Medronate/analogs & derivatives , Aged, 80 and over , Buttocks/diagnostic imaging , Humans , Male , Radionuclide Imaging , RadiopharmaceuticalsABSTRACT
A 66-year-old woman was referred for a bone scan to assess back pain on a background of breast cancer, melanoma, and rheumatic heart disease. The scan appearance was suspicious for a localized soft tissue neoplasm. An FDG coincidence positron emission tomography (PET) study demonstrated a large FDG-avid soft tissue abnormality. Staphylococcus aureus was isolated from a subsequent needle biopsy. This case illustrates the use of FDG-PET in infection imaging, as well as demonstrating the potential pitfalls in nuclear oncology. Because FDG is not tumor-specific, accumulation in benign lesions may give rise to false-positive results despite a high pretest probability for malignancy.
