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Year : 2022  |  Volume : 37  |  Issue : 3  |  Page : 277-278  

F-18 PSMA uptake in male breast cancer during restaging evaluation of carcinoma prostate


1 Department of Nuclear Medicine, Apollo Hospitals, Sector 23, CBD Belapur, Navi Mumbai, India
2 Department of Oncosurgery, Apollo Hospitals, Sector 23, CBD Belapur, Navi Mumbai, India
3 Department of Pathology, Apollo Hospitals, Sector 23, CBD Belapur, Navi Mumbai, India

Date of Submission12-Aug-2021
Date of Decision07-Sep-2021
Date of Acceptance27-Oct-2021
Date of Web Publication02-Nov-2022

Correspondence Address:
Dr. Anand Zade
Department of Nuclear Medicine, Apollo Hospitals, Sector 23, CBD Belapur, Navi Mumbai - 400 614, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.ijnm_127_21

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   Abstract 


Fluorine-18 prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography scan is widely used for restaging of prostate cancer. We present a case where false-positive PSMA uptake was seen in metachronous carcinoma breast during restaging workup of carcinoma prostate.

Keywords: Carcinoma breast, prostate-specific membrane antigen pitfall, prostate-specific membrane antigen positron emission tomography-computed tomography


How to cite this article:
Zade A, Shetty S, Ambekar A, Karpe M. F-18 PSMA uptake in male breast cancer during restaging evaluation of carcinoma prostate. Indian J Nucl Med 2022;37:277-8

How to cite this URL:
Zade A, Shetty S, Ambekar A, Karpe M. F-18 PSMA uptake in male breast cancer during restaging evaluation of carcinoma prostate. Indian J Nucl Med [serial online] 2022 [cited 2022 Nov 29];37:277-8. Available from: https://www.ijnm.in/text.asp?2022/37/3/277/360256



A 77-year-old gentleman with carcinoma prostate, post orchiectomy with raised serum PSA level of 39.1 ng/ml was referred for fluorine-18 prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT) scan as a part of restaging work up [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e. Maximum intensity projected (MIP) image (a), axial CT (b), and axial fused images (c) showed increased tracer uptake in both lobes of prostate (arrows) consistent with disease recurrence. Increased PSMA uptake was also noted in the soft tissue mass in right breast parenchyma (arrowhead) in MIP (A), axial CT (d), and axial fused images (e). Considering the fact that breast metastasis from carcinoma prostate is rare and that PSMA is also expressed in neovasculature of nonprostatic malignancies, the possibility of metachronous carcinoma right breast was contemplated. Histology of biopsy from the right breast mass [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, [Figure 2]e revealed infiltrating ductal carcinoma of intermediate nuclear grade (a). On immunohistochemistry, the tumor cells expressed Pan CK (B) and CK7 (a). The cells were immunonegative for CK20 (d) and PSA (e).
Figure 1: Maximum intensity projected image (a), axial computed tomography (b), and axial fused images (c) show increased tracer uptake in both lobes of prostate (arrows) consistent with disease recurrence. Increased prostate-specific membrane antigen uptake was also noted in the soft tissue mass in right breast parenchyma (arrowhead) in maximum intensity projected (a), axial computed tomography (d), and axial fused images (e)

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Figure 2: Histology of biopsy from the right breast mass revealed infiltrating ductal carcinoma of intermediate nuclear grade (a). On immunohistochemistry, the tumor cells expressed Pan CK (b) and CK7 (c). The cells were immunonegative for CK20 (d) and PSA (e)

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Patients with prostate cancer who are on hormonal therapy often present with gynecomastia which may be unilateral or bilateral. It is important to differentiate unilateral gynecomastia from primary breast malignancy and metastasis of prostate cancer as it has implications in treatment as well as prognosis.[1],[2],[3] Since PSMA is expressed in gynecomastia as well as primary breast carcinoma, it is not always possible to differentiate these clinical entities noninvasively on a PSMA PET-CT scan.[4],[5],[6],[7],[8] Biopsy with immunohistochemistry (IHC) for hormonal receptor and PSA expression not only helps in diagnosis but also guides further hormonal treatment. PSA staining differentiates primary breast carcinoma from metastatic prostatic carcinoma.[9],[10] In the present case, PSA staining was negative suggestive of metachronous breast carcinoma. The knowledge of this imaging pitfall is crucial to avoid misinterpretation and guide appropriate treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Fagerlund A, Cormio L, Palangi L, Lewin R, Santanelli di Pompeo F, Elander A, et al. Gynecomastia in patients with prostate cancer: A systematic review. PLoS One 2015;10:e0136094.  Back to cited text no. 1
    
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Di Lorenzo G, Perdonà S, De Placido S, D'Armiento M, Gallo A, Damiano R, et al. Gynecomastia and breast pain induced by adjuvant therapy with bicalutamide after radical prostatectomy in patients with prostate cancer: The role of tamoxifen and radiotherapy. J Urol 2005;174:2197-203.  Back to cited text no. 2
    
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Moosavi L, Kim P, Uche A, Cobos E. A synchronous diagnosis of metastatic male breast cancer and prostate cancer. J Investig Med High Impact Case Rep 2019;7:2324709619847230.  Back to cited text no. 3
    
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Sasikumar A, Joy A, Nair BP, Pillai MR, Madhavan J. False positive uptake in bilateral gynecomastia on 68Ga-PSMA PET/CT scan. Clin Nucl Med 2017;42:e412-4.  Back to cited text no. 4
    
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Kumar R, Mittal BR, Bhattacharya A, Singh H, Singh SK. Synchronous detection of male breast cancer and prostatic cancer in a patient with suspected prostatic carcinoma on 68Ga-PSMA PET/CT imaging. Clin Nucl Med 2018;43:431-2.  Back to cited text no. 5
    
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Marafi F, Sasikumar A, Alfeeli M, Thuruthel S. 18F-PSMA 1007 uptake in a man with metastatic breast cancer. Clin Nucl Med 2020;45:e276-8.  Back to cited text no. 6
    
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Bertagna F, Albano D, Cerudelli E, Gazzilli M, Tomasini D, Bonù M, et al. Radiolabelled PSMA PET/CT in breast cancer. A systematic review. Nucl Med Rev Cent East Eur 2020;23:32-5.  Back to cited text no. 7
    
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Kasoha M, Unger C, Solomayer EF, Bohle RM, Zaharia C, Khreich F, et al. Prostate-Specific Membrane Antigen (PSMA) expression in breast cancer and its metastases. Clin Exp Metastasis 2017;34:479-90.  Back to cited text no. 8
    
9.
Kraus TS, Cohen C, Siddiqui MT. Prostate-specific antigen and hormone receptor expression in male and female breast carcinoma. Diagn Pathol 2010;5:63.  Back to cited text no. 9
    
10.
Takuwa H, Tsuji W, Shintaku M, Yotsumoto F. Hormone signaling via androgen receptor affects breast cancer and prostate cancer in a male patient: A case report. BMC Cancer 2018;18:1282.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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