18F-Choline PET/CT-Positive Lytic Bone Lesions in Prostate Cancer and Accidental Myeloma Detection

Abstract

F-choline PET/CT was performed for suspected prostate cancer relapse in a 67-year-old man with hip pain and a rapid rise in prostate-specific antigen values (1.1 ng/mL). PET imaging showed an area of increased F-choline bone uptake in the right ischium. Coregistered CT images showed a lytic bone lesion. The infrequent CT appearance of a possible prostate carcinoma metastasis led to additional laboratory testing that showed a monoclonal γ-peak and to subsequent biopsy, which revealed a solitary plasmocytoma.

Metastatic prostate cancer with bone marrow infiltration mimicking multiple myeloma

“…Several cases have been reported indicating the difficulties related to concomitant diagnosis of metastatic prostate cancer and multiple myeloma in older male patients . Multiple myeloma is typically associated with osteolytic lesions while bone metastases related to prostate cancer is typically revealing osteosclerotic lesions (Figs.…”

“…In case of doubt, we recommend to perform a fine needle aspiration (FNA) in order to distinguish between myeloma-and prostate cancer-related bone metastases/lesions. Several cases have been reported indicating the difficulties related to concomitant diagnosis of metastatic prostate cancer and multiple myeloma in older male patients [2][3][4][5][6]. Multiple myeloma is typically associated with osteolytic lesions while bone metastases related to prostate cancer is typically revealing osteosclerotic lesions ( Figs.…”

“…In this case, we would like to raise attention to the possibility of concomitant presence of metastatic prostate cancer and plasma cell disorder in older male patients. The exact differentiation between multiple myeloma and metastatic prostate cancer is challenging as bone lesions/metastases are typically seen in both tumor entities . Profound knowledge and experience with both tumor entities are required in order to exactly define and characterize both malignancies.…”

Morbidity and Mortality: A Case Report of Metastatic Bone Disease

“…Advanced prostate cancer and MM are two very distinct malignancies with differing underlying pathogenesis and management; however, they share several overlapping clinical features, especially in late or advanced disease, which may pose a diagnostic challenge for clinicians [1-2]. MM is typically associated with lytic bone lesions while prostate cancer typically presents with osteoblastic lesions; however, prostate cancer may present as osteolytic bone lesions as well [3-4].…”

18F-methylcholine (FCH) PET/CT Imaging: Physiological Distribution, Pitfalls and Imaging Pearls

“…8.4), glioma, medulloblastoma [9], clival chordoma (Fig. 8.5) Extracranial: Warthin's tumour, nasopharyngeal carcinoma [19] Neck Thyroid tumours (papillary [20], Hurthle cell, follicular carcinoma, lymphoma [21]) Parathyroid adenoma Chest Mediastinum: Thymic carcinoma, oesophageal carcinoma [22] Lung carcinoma (squamous cell carcinoma) [11] Abdomen Adrenocortical carcinoma [23] GI malignancies (gastric, pancreatic and colon malignancy) Pelvis Bladder carcinoma [13] Testicular tumours (Leydig cell tumour) Skeletal Solitary: plasmacytoma [24], bone malignancy Multifocal: multiple myeloma [25,26], metastatic involvement due to synchronous malignancy General Lymphoma (DLBCL, Hodgkin's lymphoma) [27,28] Neurofibroma [29] Paraganglioma [30] Table 8. 4 Reported literature on various benign conditions with positive choline uptake that can lead to potential false positive interpretation Head and neck Tumefactive cerebral lesions (e.g.…”