‘Sometimes it’s good to see what you didn’t expect.’ 65-year-old male patient was diagnosed with
carcinoma of the prostate in 2014. He underwent TURP and bilateral orchidectomy in 2014. The patient was lost to follow up after that. Recently he presented with reduced appetite and weight loss since 1 month. His USG abdomen showed pelvic and retroperitoneal adenopathy. His Sr. PSA level was normal. However, in view of known carcinoma of the prostate, metastatic disease was suspected and the patient was referred for evaluation of disease status. The whole body FDG PET-CT scan was done 75 min after injection of FDG intravenously. The scan showed hypermetabolic enlarged nasopharyngeal tonsil, multiple enlarged hypermetabolic nodes on both sides of the diaphragm, hypermetabolic spleen and soft tissue nodules in the lumbar region. In addition, diffusely increased FDG uptake was seen in skin and the subcutaneous plane of the skull, cervical region, thorax, arms and upper abdomen with thickening and fat stranding. Prostate gland was of normal size with no abnormal FDG uptake.
In view of predominantly nodal disease with very intense FDG uptake (SUV max 27.7 in the left common iliac node), the possibility of lymphoproliferative disease was raised in the report. Biopsy from left axillary node confirmed the same. Hence, in this case, FDG PET-CT scan was not only able to rule out any recurrent prostatic carcinoma but was able to diagnose the lymphoproliferative disease with high certainty. Cutaneous involvement by the disease which otherwise is difficult to the image was also observed very well in this scan. It helped in guiding site for biopsy. Staging of the disease was completed in the same scan. Hence there was no need of any further imaging investigation. The whole body FDG PET-CT scan served as ‘one-stop-shop’ for this patient.