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Case Reports
. 2021 Sep 17;57(9):975.
doi: 10.3390/medicina57090975.

Concomitant Prostate Cancer and Hodgkin Lymphoma: A Differential Diagnosis Guided by a Combined 68Ga-PSMA-11 and 18F-FDG PET/CT Approach

Alberto Miceli  1 , Mattia Riondato  2 , Francesca D'Amico  1 , Maria Isabella Donegani  1 , Nataniele Piol  3 , Marco Mora  3 , Bruno Spina  3 , Silvia Morbelli  1   2 , Matteo Bauckneht  2
Affiliations
Free PMC article
Case Reports

Concomitant Prostate Cancer and Hodgkin Lymphoma: A Differential Diagnosis Guided by a Combined 68Ga-PSMA-11 and 18F-FDG PET/CT Approach

Alberto Miceli et al. Medicina (Kaunas). .
Free PMC article

Abstract

Here we report the case of concomitant favorable-risk prostate cancer and Hodgkin Lymphoma in a 38-year old male. 68Ga-Prostate Specific Membrane Antigen-11 Positron Emission Tomography/Computed Tomography (68Ga-PSMA-11 PET/CT) was performed for staging purposes, showing the focal PSMA prostatic uptake as well as the presence of enlarged low-PSMA expressing mediastinal lymphadenopathies, thus raising the suspicion of another malignancy. A subsequent 18F-Fluorodeoxyglucose (18F-FDG) PET/CT demonstrated a high FDG-avidity by mediastinal lymphadenopathies as opposed to the low prostate cancer FDG uptake. Of note, both tumor entities were clearly detected by the two scans. However, different ranges in terms of Maximum Standardized Uptake Value (SUVmax) uptake allowed the discrimination between the two tumor entities. At the subsequent mediastinal lymph nodal biopsy, the coexistence of Hodgkin lymphoma was documented. The present case suggests that even if specific for prostate cancer, 68Ga-PSMA-11 PET/CT may raise the suspicion of other concurrent malignancies thanks to its non-receptor bounding mechanism. Further, it shows that in certain cases, the combination of 18F-FDG and 68Ga-PSMA PET/CT imaging may non-invasively guide the clinical management, optimizing the diagnostic process and the subsequent therapeutic interventions.

Keywords: FDG PET/CT; Hodgkin lymphoma; PSMA PET/CT; prostate cancer.

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Conflict of interest statement

S.M. received speaker honoraria from General Electric and Eli-Lilly. The other authors declare they have no conflict of interest.

Figures

Figure 1
Figure 1
The central panel displays the Maximum Intensity Projection (MIP) of 68Ga-PSMA-11 and 18F-FDG PET/CT scans. The left axial hybrid PET/CT images show the focal 68Ga-PSMA uptake at the peripheral zone of the right prostatic lobe (yellow) and the mild tracer uptake by enlarged mediastinal lymph nodes (red). The right axial hybrid PET/CT images show the high 18F-FDG uptake by the enlarged mediastinal lymphatic stations (red) and the low 18F-FDG uptake by the peripheral zone of the right prostatic lobe (yellow).
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