We present a rare case of vas deferens involvement in high-grade prostate adenocarcinoma, detected by both [68Ga]Ga-PSMA PET/CT and [99mTc]Tc-PSMA SPECT/CT imaging. A 68-year-old male with elevated PSA (Gleason score 4+5) showed locoregional disease involving the prostate, left seminal vesicle, and distal vas deferens on both PET/CT and SPECT/CT scans, with no regional or distant metastasis. This case highlights the value of PSMA imaging in detecting unusual metastatic patterns as well as the clinical utility of [99mTc]Tc-PSMA SPECT/CT as an accessible alternative to PET/CT. The supplementary file reviews additional reports of PSMA-avid metastases in male genital structures.
Osteomas are benign, slow-growing bone tumors, most frequently found in the nose and paranasal sinuses. We report the case of a 69-year-old male with a history of low-risk prostate adenocarcinoma who was under active surveillance. He was referred for [99mTc]Tc-MDP bone scintigraphy and [99mTc]Tc-HYNIC-PSMA11 imaging due to a rising PSA level. Incidentally, an osteoma was identified in the left frontal sinus, demonstrating intense uptake on the bone scan and faint uptake on PSMA imaging. This case highlights the potential for PSMA ligand uptake in benign osseous lesions and underscores the importance of correlating functional and anatomical imaging to avoid misinterpretation and ensure accurate diagnosis and appropriate patient management.
Understanding the occurrence of false positive results for radioactive iodine absorption in whole body scans is crucial for differentiating these cases from actual metastases. The implementation of SPECT/CTtechnology has significantly facilitated this process for medical professionals. This study presents a case involving a 46-year-old female patient who underwent a total thyroidectomy as a treatment for thyroid cancer (papillary thyroid carcinoma), followed by radioactive iodine therapy. The post-treatment whole body scan revealed the presence of a diffuse radioiodine-avid lesion in the pelvic region, which was later identified as multiple uterine myomas through additional investigations utilizing SPECT/low-dose CT scan and MRI findings.
Large-vessel vasculitis (LVV), including Takayasu arteritis and giant cell arteritis, is a rare inflammatory condition affecting the aorta and its major branches. This case report describes a 33-year-old male with fever of unknown origin (FUO), anemia, and elevated inflammatory markers. Initial imaging was inconclusive, but Fluorodeoxyglucose Positron Emission Tomography - Computed Tomography ([18F]FDG PET-CT) revealed diffuse uptake in major arteries (carotid, subclavian, brachiocephalic, aorta, and pulmonary trunk) with an SUVmax of 6.91, indicating active vasculitis. The absence of [18F]FDG-avid lymphadenopathy ruled out malignancy or infection, while faint uptake in bilateral femoral arteries suggested systemic involvement. Physiological uptake in organs like the gastrointestinal tract and adrenal glands showed no malignancy, and axial skeleton activity was linked to anemia. This case highlights [18F]FDG PET-CT's role in early LVV detection, stressing the need for timely diagnosis to prevent irreversible vascular damage and the importance of integrating imaging with clinical evaluation for effective management.
A 69-year-old male patient diagnosed with prostate adenocarcinoma underwent whole-body bone scintigraphy utilizing [99mTc]Tc-methylene diphosphonate (MDP) for initial staging. During the procedure, an unexpected focal uptake of the radiotracer was noted, which appeared to resemble metastasis to the pubic bone or prostate cancer. However, this finding was ultimately determined to be due to a displaced bladder stone located within the prostatic urethra. This case highlights the importance of reviewing the patient's previous imaging studies, utilizing SPECT/CT imaging, and considering urinary tract stones as a potential differential diagnosis when abnormal radiotracer uptake is detected in the pelvic region below the bladder.
