Singh Dalveer, Horneman Roslyn, Nagra Navjot Kaur
Qscan Radiology Clinics (QLD), 123 Nerang Street Southport, Queensland, 4215, Australia.
Hell J Nucl Med. 2018 May-Aug;21(2):145-147. doi: 10.1967/s002449910805. Epub 2018 Jul 12.
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.
We present a case of a 55 years old man with prostate adenocarcinoma, with incidentally found pancreatic and thyroid lesions showing PSMA avidity.
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 (F-FDG) PET/CT.
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-[F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (F-DCFPyL)-PSMA PET/CT to detect IPAS. Furthermore we highlight the value of nuclear medicine diagnostic work up in complex cases.
