case_images: PMC10714977_01
case_images: Long segment of abnormally increased [18F]DCFPyL uptake in the terminal ileum (identified by the black and white arrows in the subfigures). (A) [18F]DCFPyL PET/CT uptake in terminal ileum on a coronal plane. (B) Axial CT Image. (C) Axial PET Imaging. (D) Axial [18F]DCFPyL PET/CT fusion imaging.
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case_images: Biopsies demonstrated chronic active inflammation and PSMA IHC showed increased numbers of PSMA positive cells in inflamed sections (Supplementary Figure 1).
case_images: Ileocolonoscopy with inflammation and pseudopolyposis from the anal verge up to 20cm and terminal ileum stricture (A) requiring balloon dilatation (B) with successful dilatation (C).
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case_images: IHC of inflamed biopsies, identified occasionally increased PSMA expression in the apical epithelial membrane, and also numerous PSMA positive cells throughout the mucosa (Supplementary Figure 2). [18F]DCFPyL PET/CT imaging was performed.
case_images: PSMA immunohistochemistry (IHC) on full-thickness distal colon sections. Arrows and arrowheads identifying area of PSMA staining on various cross-sections of the colon and ileum (A-D).
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case_images: To assess PSMA expression in the region of distal colon located 20 cm from the anal verge, where inflammation was visualized on endoscopic exam but was not detected by [18F]DCFPyL PET/CT, PSMA immunohistochemistry (IHC) was performed on full-thickness distal colon sections, acquired during his abdominoperineal resection using the validated antibody 1A11 (Figure 3) according to previously described methods. Interestingly, heterogeneously increased PSMA expression was detected in colon epithelial cells adjacent to sites of severe inflammation, where it displayed an intracellular, cytoplasmic expression pattern (Figure 3C), and thus may have been inaccessible to the radiotracer, explaining the apparent discrepancy between endoscopic and histologic disease, and [18F]DCFPyL imaging at this site. In agreement with this hypothesis, IHC performed on terminal ileum biopsies from this patient exhibited a strikingly different pattern of PSMA expression, with concentrated signal at the apical brush border membrane in addition to increased intracellular expression (Figure 3D).
case_images: PMC10714977_02
case_images: Long segment of abnormally increased [18F]DCFPyL uptake in the terminal ileum (identified by the black and white arrows in the subfigures). (A) [18F]DCFPyL PET/CT uptake in terminal ileum on a coronal plane. (B) Axial CT Image. (C) Axial PET Imaging. (D) Axial [18F]DCFPyL PET/CT fusion imaging.
case_images: CEG-16-237-g0001.jpg
case_images: PMC10714977_02_CEG-16-237-g0001.jpg
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case_images: Biopsies demonstrated chronic active inflammation and PSMA IHC showed increased numbers of PSMA positive cells in inflamed sections (Supplementary Figure 1).
case_images: Erythema, friability, and deep ulcerations in the rectum and sigmoid colon on colonoscopy (A and B).
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case_images: His colonoscopy showed marked erythema, friability, and deep ulcerations in the rectum and sigmoid colon (Figure 4).
case_images: Abnormally increased [18F]DCFPyL uptake in the sigmoid colon and rectum on PET/CT. (A) [18F]DCFPyL PET/CT uptake in the sigmoid colon (identified by the arrows and arrowheads) on a coronal plane. (B) Axial CT Image with arrows identifying active inflammation in the sigmoid colon and rectum. (C) Axial PET Imaging arrows identifying active inflammation in the sigmoid colon and rectum. (D) Axial [18F]DCFPyL PET/CT fusion imaging with arrows identifying active inflammation in the sigmoid colon and rectum.
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case_images: PET/CT scan demonstrated abnormally increased [18F]DCFPyL uptake in the sigmoid colon and rectum (Figure 5), in areas of mucosal inflammation.
case_images: PMC10714977_03
case_images: Ileocolonoscopy with inflammation and pseudopolyposis from the anal verge up to 20cm and terminal ileum stricture (A) requiring balloon dilatation (B) with successful dilatation (C).
case_images: CEG-16-237-g0002.jpg
case_images: PMC10714977_03_CEG-16-237-g0002.jpg
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case_images: IHC of inflamed biopsies, identified occasionally increased PSMA expression in the apical epithelial membrane, and also numerous PSMA positive cells throughout the mucosa (Supplementary Figure 2). [18F]DCFPyL PET/CT imaging was performed.
case_images: Flexible sigmoidoscopy demonstrating Mayo endoscopic subscore 3 (A-C).
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case_images: He underwent a flexible sigmoidoscopy to 20 cm from the anal verge which demonstrated spontaneous bleeding and ulcerations throughout the examined mucosa (Mayo endoscopic subscore 3) (Figure 6).
case_images: [18F]DCFPyL PET/CT demonstrating abnormally increased uptake in the descending colon (identified by red arrows), sigmoid colon, and rectum corresponding to findings on endoscopy. (A) [18F]DCFPyL PET/CT uptake in the descending colon on a coronal plane. (B) Axial CT Image with arrows identifying active inflammation in the descending colon. (C) Axial PET Imaging arrows identifying active inflammation in the descending colon. (D) Axial [18F]DCFPyL PET/CT fusion imaging identifying active inflammation in the descending colon.
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case_images: PET/CT demonstrated abnormally increased [18F]DCFPyL uptake in the descending colon, sigmoid colon, and rectum (Figure 7), in a distribution corresponding to the findings on endoscopy.