Morassi Mauro, Bonacina Mattia, Bnà Claudio, Zaniboni Alberto, Savelli Giordano
Division of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy.
Division of Nuclear Medicine, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy.
Diagnostics (Basel). 2020 Jun 8;10(6):385. doi: 10.3390/diagnostics10060385.
Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache and diplopia. Fluorocholine (F) chloride (F-FCH) is an analog of choline in which a hydrogen atom has been replaced by fluorine (F). After crossing the cell membrane by a carrier-mediated mechanism, choline is phosphorylated by choline kinase to produce phosphorylcholine. F-FCH positron emission tomography-computed tomography (PET/CT) is widely used to stage and restage patients affected by prostate cancer with good sensitivity. F-FCH PET/CT showed disease progression with the onset of multiple skull lesions. Numerous suspicious dural hypermetabolic lesions indicating neoplastic involvement were detected along the fronto-parietal convexities, in the left fronto-orbital region and right lateral wall of the orbit, concerning for metastases in these regions. A contrast-enhanced computed tomography (CECT) scan was performed which showed corresponding enhancing tissue which correlated with the PET findings. The final imaging diagnosis was osteo-dural metastases from prostate cancer associated with poor outcome. Awareness of this pattern of metastases may be of clinical relevance in order to avoid unnecessary invasive diagnostic procedures in groups of patients with a dismal prognosis.
广泛硬脊膜转移的前列腺癌非常罕见，文献中仅有少数病例报道。我们报告一例74岁晚期前列腺癌患者，其临床状况相对良好。该患者因头痛和复视而复诊。氯化氟胆碱（F-FCH）是胆碱的类似物，其中一个氢原子被氟（F）取代。通过载体介导机制穿过细胞膜后，胆碱被胆碱激酶磷酸化生成磷酸胆碱。F-FCH正电子发射断层扫描-计算机断层扫描（PET/CT）以良好的敏感性广泛用于前列腺癌患者的分期和再分期。F-FCH PET/CT显示随着多个颅骨病变的出现疾病进展。沿额顶叶凸面、左侧额眶区域和眼眶右侧壁检测到大量可疑的硬脊膜高代谢病变，提示肿瘤累及，考虑这些区域有转移。进行了增强计算机断层扫描（CECT），显示与PET结果相关的相应强化组织。最终影像学诊断为前列腺癌骨-硬脊膜转移，预后不良。认识到这种转移模式可能具有临床意义，以便在预后不佳的患者群体中避免不必要的侵入性诊断程序。
