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

De novo metastatic prostate cancer with neuroendocrine differentiation (NED) at first presentation is extremely rare. A ۶۵-year-old man (Gleason score ۵+۴, first assumed to be acinar adenocarcinoma), was referred for [۹۹mTc]Tc-HYNIC-PSMA SPECT/CT due to low back pain. The PSA levels were ۸ and <۰.۰۷ 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 ۲nd 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.

کلیدواژه ها:

prostate cancer ، Neuroendocrine differentiation ، [۹۹mTc]Tc-PSMA ، SPECT/CT