case_images: PMC9354022_01
case_images: Hybrid CT + PET transaxial images from 18F-FDG PET/CT (A1) and from 18F-PSMA-PET/CT (A2) examinations performed by patient 1 in September 2021, hybrid CT + PET transaxial (B1) and PET MIP total-body (B2) images from 18F-PSMA-PET/CT examination performed by patient 2 in October 2021, hybrid CT + PET transaxial (C1) and PET MIP total-body (C2) images from 18F-PSMA-PET/CT examination performed by patient 3 in January 2022. PSMA-PET scan performed by patient 1 revealed an intense tracer uptake in the prostate and in several bone lesions, such as in the right ala of the sacrum (A2), while the hepatic lesions showed no tracer uptake. The following FDG PET scan revealed high FDG uptake in the liver and in several bone lesions, such as in the right ala of the sacrum (A1). PSMA-PET scan performed by patient 2 revealed high tracer uptake in the liver (B1, B2), bone (B2) and lymph nodes (B2). PSMA-PET scan performed by patient 3 showed tracer-avid foci in the prostate and in several osteoblastic lesions, such as in the left femur head (C1, C2), while no uptake was detected in the abdominal lymphadenopathies (C2). CT, computed tomography; PET, positron emission tomography; FDG, fluorodeoxyglucose; PSMA,prostate-specific membrane antigen; MIP, maximum intensity projection.
case_images: fonc-12-937713-g002.jpg
case_images: PMC9354022_03_fonc-12-937713-g002.jpg
case_images: f2
case_images: In January 2022, a 18F-PSMA-PET/CT was performed, showing tracer-avid foci in the prostate and in several osteoblastic lesions, while no uptake was detected in the abdominal lymphadenopathies ( Figure 2C1, 2 ).
case_images: PMC9354022_02
case_images: Hybrid CT + PET transaxial images from 18F-FDG PET/CT (A1) and from 18F-PSMA-PET/CT (A2) examinations performed by patient 1 in September 2021, hybrid CT + PET transaxial (B1) and PET MIP total-body (B2) images from 18F-PSMA-PET/CT examination performed by patient 2 in October 2021, hybrid CT + PET transaxial (C1) and PET MIP total-body (C2) images from 18F-PSMA-PET/CT examination performed by patient 3 in January 2022. PSMA-PET scan performed by patient 1 revealed an intense tracer uptake in the prostate and in several bone lesions, such as in the right ala of the sacrum (A2), while the hepatic lesions showed no tracer uptake. The following FDG PET scan revealed high FDG uptake in the liver and in several bone lesions, such as in the right ala of the sacrum (A1). PSMA-PET scan performed by patient 2 revealed high tracer uptake in the liver (B1, B2), bone (B2) and lymph nodes (B2). PSMA-PET scan performed by patient 3 showed tracer-avid foci in the prostate and in several osteoblastic lesions, such as in the left femur head (C1, C2), while no uptake was detected in the abdominal lymphadenopathies (C2). CT, computed tomography; PET, positron emission tomography; FDG, fluorodeoxyglucose; PSMA,prostate-specific membrane antigen; MIP, maximum intensity projection.
case_images: fonc-12-937713-g002.jpg
case_images: PMC9354022_03_fonc-12-937713-g002.jpg
case_images: f2
case_images: In January 2022, a 18F-PSMA-PET/CT was performed, showing tracer-avid foci in the prostate and in several osteoblastic lesions, while no uptake was detected in the abdominal lymphadenopathies ( Figure 2C1, 2 ).
case_images: Sections are from patient 2 prostate and liver biopsies and stained as labelled. Primary tumor was a NKX3.1+ synaptophysin- chromogranin- prostate adenocarcinoma (A-D) with foci of NKX3.1- synaptophysin+ chromogranin+ high grade neuroendocrine cardnoma (E-H). Liver metastases were characterized by a NKX3.1- synaptophysin+chromogranin+TTFl+ small cell neuroendocrine phenotype (I-M). Original magnifications: 4X (A), 10X (B-D, G, I), 20X (E, F, H, J-M). H&N, hematoxylin and eosin; TTF1, thyroid transcription factor 1.
case_images: fonc-12-937713-g003.jpg
case_images: PMC9354022_02_fonc-12-937713-g003.jpg
case_images: f3
case_images: The patient underwent TURB and prostate biopsies, both reporting a Gleason score 4 + 5 prostate adenocarcinoma ( Figures 3A-D ). Additional immunohistochemical staining showed foci of high grade neuroendocrine differentiation ( Figures 3E-H ). Figures 3I-M ) with a Ki67 expression of 70%. The histological examination thus hinted at a treatment-induced selection of the neuroendocrine cellular clone previously described in the former prostate biopsy. Five cycles of chemotherapy with Carboplatin and Etoposide in association to Atezolizumab, followed by maintenance therapy with Atezolizumab, were then administered.
case_images: PMC9354022_03
case_images: Hybrid CT + PET transaxial images from 18F-FDG PET/CT (A1) and from 18F-PSMA-PET/CT (A2) examinations performed by patient 1 in September 2021, hybrid CT + PET transaxial (B1) and PET MIP total-body (B2) images from 18F-PSMA-PET/CT examination performed by patient 2 in October 2021, hybrid CT + PET transaxial (C1) and PET MIP total-body (C2) images from 18F-PSMA-PET/CT examination performed by patient 3 in January 2022. PSMA-PET scan performed by patient 1 revealed an intense tracer uptake in the prostate and in several bone lesions, such as in the right ala of the sacrum (A2), while the hepatic lesions showed no tracer uptake. The following FDG PET scan revealed high FDG uptake in the liver and in several bone lesions, such as in the right ala of the sacrum (A1). PSMA-PET scan performed by patient 2 revealed high tracer uptake in the liver (B1, B2), bone (B2) and lymph nodes (B2). PSMA-PET scan performed by patient 3 showed tracer-avid foci in the prostate and in several osteoblastic lesions, such as in the left femur head (C1, C2), while no uptake was detected in the abdominal lymphadenopathies (C2). CT, computed tomography; PET, positron emission tomography; FDG, fluorodeoxyglucose; PSMA,prostate-specific membrane antigen; MIP, maximum intensity projection.
case_images: fonc-12-937713-g002.jpg
case_images: PMC9354022_03_fonc-12-937713-g002.jpg
case_images: f2
case_images: In January 2022, a 18F-PSMA-PET/CT was performed, showing tracer-avid foci in the prostate and in several osteoblastic lesions, while no uptake was detected in the abdominal lymphadenopathies ( Figure 2C1, 2 ).