68Ga PSMA Uptake at Roux-en-Y Eso-jejunostomy Junction Mimicking the Recurrence of Gastric Carcinoma in PET/CT

Esra Arslan; Tamer Aksoy; Merve Cin; Coşkun Çakır; Fadime Didem Can Trabulus; Tevfik Fikret Çermik

doi:10.4274/mirt.galenos.2020.86729

⁶⁸Ga PSMA Uptake at Roux-en-Y Eso-jejunostomy Junction Mimicking the Recurrence of Gastric Carcinoma in PET/CT

Mol Imaging Radionucl Ther. 2021 Feb 9;30(1):63-66. doi: 10.4274/mirt.galenos.2020.86729.

Authors

Esra Arslan¹, Tamer Aksoy¹, Merve Cin², Coşkun Çakır³, Fadime Didem Can Trabulus³, Tevfik Fikret Çermik¹

Affiliations

¹ University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey.
² University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Department of Pathology, İstanbul, Turkey.
³ University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Surgery, Istanbul, Turkey.

Abstract
in English, Turkish

A 67-year-old male patient had undergone total gastrectomy and Roux-en-Y eso-jejunostomy 3 years ago for the treatment of tubular adenocarcinoma located at the corpus of the stomach. The patient was diagnosed with Gleason score 8 (4+4) metastatic prostate cancer during the follow-up period and received hormone therapy. Owing to his elevated prostate-specific antigen levels (77 ng/mL), his clinician referred him gallium-68 (⁶⁸Ga) prostate-specific membrane antigen 11 (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT showed multiple ⁶⁸Ga PSMA receptor-positive skeletal lesions and linear PSMA activity at the eso-jejunostomy junction. He was then referred to undergo ¹⁸fluorine-fluorodeoxyglucose (¹⁸F-FDG) PET/CT to screen for gastric carcinoma recurrence. PET/CT images demonstrated no ¹⁸F-FDG avid lesion. However, endoscopy and biopsy performed with samples from the eso-jejunostomy junction revealed superficial benign squamous epithelial fragments.

Altmış yedi yaşında erkek hastaya mide korpusunda tespit edilen tubular adenokarsinom nedeniyle 3 yıl önce total gastrektomi ve Roux-en-Y oeso-jejunostomi yapılmıştır. Takip süresince hasta Gleason skoru 8 (4+4) metastatik prostat kanseri tanısı da alarak hormonoterapi uygulandı. Prostat spesifik antijen düzeylerinde (77 ng/mL) yükselme saptanması nedeniyle yeniden evreleme amaçlı galyum-68 prostat spesifik membran antijeni 11 (PSMA) pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) görüntüleme için hasta kliniğimize refere edildi. ⁶⁸Ga PSMA PET/BT görüntülemesinde oeso-jejunostomi kavşağında lineer PSMA aktivitesi ve multipl PSMA reseptör pozitif iskelet lezyonları saptandı. Gastrik karsinomun nüksü şüphesi nedeni ile hasta ¹⁸F-FDG PET/BT incelemesi açısından yeniden kliniğimize sevk edildi. ¹⁸F-FDG PET/BT görüntülerinde FDG pozitif malign prosesi düşündürebilecek lezyon görülmedi. Oeso-jejunostomi anastomoz hattından yapılan endoskopi ve biyopsi incelemesinde yüzeyel benign skuamöz epitelyal fragmanlar saptandı.

Keywords: 18F-FDG; 68Ga-PSMA; PET/CT; gastric carcinoma; prostate carcinoma.

Abstract in English, Turkish

Abstract
in English, Turkish