case_images: PMC6352627_01
case_images: Cell block from liver lesion carcinomatous cells arranged in sheets and pseudoacinar pattern, few of them displaying vacuolated/clear cytoplasm (a and b). It also showed weak positivity for hepatocyte antibody (c) and positivity for P504S (d) which is prostate-specific cytokeratin immunohistochemistry marker
case_images: IJNM-34-54-g001.jpg
case_images: PMC6352627_01_IJNM-34-54-g001.jpg
case_images: F1
case_images: Since the liver lesion showed only weak positivity for hepatocyte antibody, additional prostate-specific IHC markers were performed on cell block from the liver lesion, which showed P504S positivity [Figure 1d], consistent with metastases from prostate cancer.
case_images: Whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography study (a; maximum intensity projection image) shows cirrhotic liver, with lesion in right lobe showing low fluorodeoxyglucose uptake (b and c; thin arrows). Increased fluorodeoxyglucose uptake noted in the left half and median lobe of prostate gland showing mild heterogeneous enhancement (d and e; black arrows). Intensely fluorodeoxyglucose-avid soft-tissue deposits noted in intraspinal extradural location at level of D5-D8 vertebrae, right paravertebral region, and along adjoining right-sided lower ribs/pleura (f and g; white arrows) along with right pleural effusion
case_images: IJNM-34-54-g002.jpg
case_images: PMC6352627_01_IJNM-34-54-g002.jpg
case_images: F2
case_images: However, in view of weak positivity for hepatocyte antibody, correlation with imaging findings were suggested. Hence, the patient was referred for F-18 FDG PET/CT [Figure 2a; maximum intensity projection image] and it revealed cirrhotic liver, with a lesion in right lobe showing low FDG uptake [Figure 2b and c; thin arrows]. Increased FDG uptake was also seen in the left half and median lobe of prostate gland showing mild heterogeneous enhancement [Figure 2d and e; black arrows]. In addition, intensely FDG-avid soft-tissue deposits were noted in intraspinal extradural location at level of D5-D8 vertebrae, right paravertebral region, and along adjoining right-sided lower ribs/pleura [Figure 2f and g; white arrows] as well as right pleural effusion.
case_images: Prostatic biopsy shows carcinomatous cells arranged in fused glandular pattern, few of them showing vacuolated cytoplasm and hyperchromatic nuclei with Gleason score of 4 + 5 = 9 (a, b). Biopsy from paravertebral soft tissue showed lymphoid tissue (c) with positivity for CD 20 (d), suggestive of lymphoma
case_images: IJNM-34-54-g003.jpg
case_images: PMC6352627_01_IJNM-34-54-g003.jpg
case_images: F3
case_images: Serum prostate-specific antigen (PSA) was elevated (82.6 ng/ml) and biopsy from prostate showed adenocarcinoma prostate with Gleason score of 4 + 5 = 9 [Figure 3a and b]. However, in view of different metabolic signature on FDG PET/CT (intense FDG uptake in intraspinal and paravertebral soft tissue versus low-to-moderate grade FDG uptake in liver and prostate lesions), trucut biopsy from paravertebral soft tissue was performed, which showed lymphoid cells [Figure 3c] and positivity for CD 20 [Figure 3d], CD 10, bcl 2, and leukocyte common antigen, consistent with non-Hodgkin's lymphoma.