case_images: PMC10752594_01
case_images: Enlarged prostate with multiple foci of high PSMA expression in the prostate, considering malignant lesions.
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case_images: Prostate magnetic resonance imaging (MRI) with T1-weighted, dynamic enhancement, and spectroscopy analysis indicated the presence of prostate tumor with involvement of the prostatic capsule and close association with bilateral seminal vesicles. PSMA PET/CT also support this diagnosis ( Figure 1 ).
case_images: A.2022.5 Prostate MR scan: review after prostate cancer treatment to consider disease progression B.2022.5 PSMA PET suggests an irregularly enlarged prostate with heterogeneous density, uneven PSMA radioactivity distribution only slightly increased, SUVmax=4.8. (B) is inconsistent with the imaging performance of the lesion in (A). C.2022.5 18F-OC PET suggests foci of high octreotide expression in the prostate, SUVmax=12.3. (C) is consistent with the imaging presentation of the lesion in (A). D.2022.5 Pelvic lymph node under 18F-OC PET, increased distribution of radioactivity is seen, SUVmax=6.2. (E) 18F-OC PET image 3 months after 177Lu-DOTA-TATE treatment, the volume of the lesion is significantly reduced compared with that before the treatment, and the level of octreotide expression is significantly reduced compared with the previous one, which is considered to be the residual tumor activity. SUVmax=5.5. (F) 18F-OC PET image 3 months after 177Lu-DOTA-TATE treatment, pelvic lymph nodes compared with (D), the expression level of octreotide was significantly reduced, which was consistent with post-treatment changes.
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case_images: Subsequently, the patient underwent 18F-AlF-NOTA-octreotide (18F-OC) PET/CT ( Figure 2 ), genetic testing, and other examinations. One month after the second treatment, a follow-up 18F-OC scan indicated a noticeable reduction or disappearance of the original lesions in comparison to previous scans, with metabolic activity trending towards normal ( Figure 2 ).
case_images: Pathological features of Prostate small cell carcinoma. (A) The tumor cells, diminutive in size and arranged in patches or in a nest-like manner, have scant cytoplasm, rendering them nearly nucleated. These nuclei are abundant with chromatin, yet the nucleoli remain indistinct (HE, 200x); Immunohistochemical image of Prostate small cell carcinoma (SP 200x). (B) positive immunohistochemical staining for CD56; (C) positive immunohistochemical staining of Ki-67(95%); (D) positive immunohistochemical staining for Synaptophysin.
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case_images: The immunohistochemistry results demonstrated broad CK expression, CD56 positivity, Synaptophysin positivity, absence of Chromogranin A, absence of TTF-1, slight CK7 positivity in a few glandular structures, weak PSA positivity in glandular structures, P504S positivity in glandular structures, slight GATA-3 positivity in glandular structures, local basal cell positivity for P63 in glandular structures, local basal cell positivity for 34betaE12 in glandular structures, absence of LCA, and a Ki-67 index of 95% ( Figure 3 ).
case_images: Illustrates a timeline of relevant diagnoses and treatments.
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case_images: f4