Iranian Journal of Nuclear Medicine

Iranian Journal of Nuclear Medicine

De novo metastatic prostate cancer with neuroendocrine differentiation: A diagnostic dilemma

Document Type : Case Report

Authors
Somaye Barashki 1
Emran Askari 1
Mahmoudreza Kalantari 2
Hadis Mohammadzadeh Kosari 1
Kamran Aryana 1
1 Nuclear Medicine Research Center, Mashhad University of Medical Science, Mashhad, Iran
2 Department of Pathology, Faculty of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
10.22034/irjnm.2024.129169.1546
Abstract
De novo metastatic prostate cancer with neuroendocrine differentiation (NED) at first presentation is extremely rare. A 65-year-old man (Gleason score 5+4, first assumed to be acinar adenocarcinoma), was referred for [99mTc]Tc-HYNIC-PSMA SPECT/CT due to low back pain. The PSA levels were 8 and <0.07 ng/mL at the time of diagnosis and prior to scintigraphy respectively. The scan revealed multiple non-PSMA-avid lesions throughout the skeleton, lung and liver, suggesting the possibility of NED or 2nd malignancy.  Second-look and review of the pathology led to change of the diagnosis to mixed small cell neuroendocrine carcinoma-acinar adenocarcinoma. This case highlights the importance of PSMA imaging in suggestion of type of the tumor which as in our case, might alter the pathologic tissue diagnosis.
Keywords
Prostate cancer
Neuroendocrine differentiation
[99mTc]Tc-PSMA
SPECT/CT
Subjects
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