[Solitary hypermetabolic bone focus in the initial extension study of a prostate carcinoma].
56 year old male who was diagnosed of Prostatic Neoplasm by transrectal biopsy after elevated PSA level was found by chance in a routine control. The initial extension study with abdominal and pelvic CT did not show significant radiological abnormalities. This was followed by a whole body bone scintigraphy with 99mTc-MDP that showed a solitary hypermetabolic lesion within skull. A SPECT study placed this lesion at the left occipital region. An MRI and a CT head scan were carried out to characterize the isotopic lesion, finding no bone abnormalities to justify the mentioned uptake. Given the absence of a radiological benign diagnosis, a further FDG-PET scan was carried out which did not show either increased glycolytic activity at the left occipital region, or in the prostatic gland. In order to guide the biopsy, a CT head scan was repeated which showed what appeared to be an incipient blastic lesion in the scale of the left occipital bone, establishing the differential diagnosis between a metastasis and a benign process. The anatomopathologic analysis of the bone tissue describes a necrotic process without inflammatory reaction (osteonecrosis).
Sampol Bas
C
C
Servicio de Medicina Nuclear, Hospital Son Dureta, Palma de Mallorca.
Peña Viloria
C
C
Giménez García
M
M
D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging* / Q000556:secondary; D014408:Biomarkers, Tumor / Q000097:blood; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D003937:Diagnosis, Differential; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D009777:Occipital Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012888:Skull Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D013669:Technetium Tc 99m Medronate / Q000493:pharmacokinetics; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D019275:Radiopharmaceuticals; D017430:Prostate-Specific Antigen; D013669:Technetium Tc 99m Medronate