De novo metastatic prostate cancer with neuroendocrine differentiation: A diagnostic dilemma
نویسندگان
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
3 Nuclear Medicine Research Center, Mashhad University of Medical Science, Mashhad, Iran
4 Nuclear Medicine Research Center, Mashhad University of Medical Science, Mashhad, Iran
5 Nuclear Medicine Research Center, Mashhad University of Medical Science, Mashhad, Iran
doi
10.22034/irjnm.2024.129169.1546چکیده
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.
