case_images: PMC5370467_01
case_images: Bone scan showing increased uptake in the left-sided pelvis suggestive for Paget disease (a). Computed tomography demonstrated coarsened and bloated pubic bone (b). The lesion showed moderate uptake of 68Ga-labeled prostate-specific membrane antigen-targeted ligand (maximal standardized uptake value up to 13.8) (c). The maximal standardized uptake value of the primary tumor in the prostate was 10.0.
case_images: CRIU2017-1654231.001.jpg
case_images: PMC5370467_01_CRIU2017-1654231.001.jpg
case_images: fig1
case_images: A bone scan revealed increased pelvic tracer uptake that was considered suspicious for Paget disease (Figure 1(a)). 68Ga-labeled prostate-specific membrane antigen-targeted ligand positron emission tomography/computed tomography (PSMA-PET/CT) showed moderate PSMA positivity of this lesion (Figure 1(b)).
case_images: CT-guided biopsy (a) showed irregular bone structure with fibrotic marrow spaces ((b) H&E; original magnification x20) containing multinucleated giant cells ((c) arrowheads; chloroacetate esterase stain; original magnification x20). Immunohistochemical staining for PSMA revealed weak PSMA expression in endothelial cells ((d) arrowhead; original magnification x20) in the Paget bone lesion.
case_images: CRIU2017-1654231.002.jpg
case_images: PMC5370467_01_CRIU2017-1654231.002.jpg
case_images: fig2
case_images: Since Paget disease has been reported to cause PSMA positivity bone lesions, a bone biopsy was obtained for final workup that confirmed the diagnosis of Paget disease (Figure 2).