Novruzov Emil, Niegisch Günter, Pauck David, Schmitt Dominik, Kuhlmann Julian, Beseoglu Kerim, Antoch Gerald, Schimmöller Lars, Giesel Frederik L, Mamlins Eduards
Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany.
Department of Urology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany.
BJR Case Rep. 2024 Nov 1;10(6):uaae041. doi: 10.1093/bjrcr/uaae041. eCollection 2024 Nov.
Prostate adenocarcinoma metastasis to brain has been reported to occur only up to 0.6% of patients and these are mostly diagnosed in autopsy series. In the setting of biochemical recurrence of prostate cancer, a suspected PSMA-avid (prostate-specific membrane antigen) lesion in the brain is still strongly suggestive of an intracranial metastasis of prostate cancer. This needs, however, a thoroughly recurrency work-up due to other potentially PSMA-avid cranial lesions, as PSMA initially was developed for the imaging of primary CNS tumours. We report of a challenging clinical case of a 71-year-old-patient with a strongly PSMA-avid lesion at the skull base. Given the medical history of a meningioma at the skull base, the further diagnostic work-up with MRI could still not rule out a malignancy, so that the patient needed to undergo a surgical excision of the tumour mass. The histological and immunohistochemical examinations revealed a relapsed CNS WHO grade 1 meningioma. From the aspect of molecular imaging and critical analysis of regular clinical care in a third-level university hospital, we consider this result very intriguing. Hence, we analyse the decision-making process and clinical course of this case in the light of molecular imaging findings.
据报道，前列腺腺癌转移至脑部的患者仅占0.6%，且大多是在尸检系列中被诊断出来的。在前列腺癌生化复发的情况下，脑部疑似PSMA（前列腺特异性膜抗原）摄取阳性的病变仍强烈提示前列腺癌颅内转移。然而，由于其他可能PSMA摄取阳性的颅内病变，这需要进行全面的复发检查，因为PSMA最初是用于原发性中枢神经系统肿瘤成像的。我们报告了一例具有挑战性的临床病例，一名71岁患者在颅底有一个强烈PSMA摄取阳性的病变。鉴于该患者有颅底脑膜瘤病史，进一步的MRI诊断检查仍不能排除恶性肿瘤，因此患者需要接受肿瘤肿块的手术切除。组织学和免疫组化检查显示为复发性世界卫生组织1级中枢神经系统脑膜瘤。从分子成像的角度以及对三级大学医院常规临床护理的批判性分析来看，我们认为这个结果非常有趣。因此，我们根据分子成像结果分析该病例的决策过程和临床病程。
