Whole body bone scan and abdominal computed tomography (CT) of a 77-year-old man with intractable back pain revealed a destructive bone lesion in the lumbar spine. The F-18 FDG PET/CT scan, performed under the impression of an unknown primary cancer, showed diffusely intense FDG uptake in the enlarged prostate and mild FDG uptake in the lumbar spine. The patient had pyuria and mild fever during admission. Laboratory findings showed elevation of the serum prostate specific antigen (95.69 ng/ml). Blood culture yielded Klebsiella pneumoniae. The prostate biopsy showed acute inflammation with no malignancy and the lumbar spine biopsy showed chronic osteomyelitis.

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Intussusception is uncommon in adults. To our knowledge, synchronous colocolic intussusceptions have never been reported in the literature. Here we described the case of a 59-year-old female of synchronous colocolic intussusceptions presenting as acute abdomen that was diagnosed by CT preoperatively. Laparotomy with radical right hemicolectomy and sigmoidectomy was undertaken without reduction of the invagination due to a significant risk of associated malignancy. The final diagnosis was synchronous adenocarcinoma of proximal transverse colon and sigmoid colon without lymph nodes or distant metastasis. The patient had an uneventful recovery. The case also emphasizes the importance of thorough exploration during surgery for bowel invagination since synchronous events may occur.

Preoperative serum VEGF-A and VEGF-D levels were significantly elevated in DTC patients with distant and lymph node metastases. These findings, when combined with other clinicopathological factors, may help in surgical decisions.