Not Every PSMA-Expressing Bone Lesion Is Prostate Cancer: Incidental Detection of Metastatic Differentiated Thyroid Carcinoma on Staging 68 Ga-PSMA-11 PET/CT.
Aishwarya Wagle, Swayamjeet Satapathy, Arvind Suresh et al.
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Case in brief
A patient with newly diagnosed high-risk prostate adenocarcinoma underwent staging 68Ga-PSMA-11 PET/CT. Alongside the primary prostatic lesion, PSMA-expressing foci were seen in the sternum and right thyroid lobe. The sternal lesion was initially presumed to represent prostate cancer metastasis, but further evaluation identified follicular variant papillary thyroid carcinoma. The scan therefore revealed a synchronous thyroid malignancy rather than all PSMA-avid findings being attributable to the prostate cancer.
What made this case unusual
A PSMA-expressing sternal lesion that appeared to indicate prostate cancer spread was instead associated with follicular variant papillary thyroid carcinoma, with a thyroid focus also detected on staging imaging.
Diagnostic / clinical pearl
PSMA uptake in a bone lesion is not specific to prostate cancer metastasis; discordant or additional PSMA-avid findings may warrant evaluation for another malignancy.
Why it matters
PSMA-PET/CT may uncover clinically occult synchronous malignancies as well as stage prostate cancer.