PMC5370467_01
Bone scan showing increased uptake in the left-sided pelvis suggestive for Paget disease (a). Computed tomography demonstrated coarsened and bloated pubic bone (b). The lesion showed moderate uptake of 68Ga-labeled prostate-specific membrane antigen-targeted ligand (maximal standardized uptake value up to 13.8) (c). The maximal standardized uptake value of the primary tumor in the prostate was 10.0.
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fig1
A bone scan revealed increased pelvic tracer uptake that was considered suspicious for Paget disease (Figure 1(a)). 68Ga-labeled prostate-specific membrane antigen-targeted ligand positron emission tomography/computed tomography (PSMA-PET/CT) showed moderate PSMA positivity of this lesion (Figure 1(b)).
CT-guided biopsy (a) showed irregular bone structure with fibrotic marrow spaces ((b) H&E; original magnification x20) containing multinucleated giant cells ((c) arrowheads; chloroacetate esterase stain; original magnification x20). Immunohistochemical staining for PSMA revealed weak PSMA expression in endothelial cells ((d) arrowhead; original magnification x20) in the Paget bone lesion.
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fig2
Since Paget disease has been reported to cause PSMA positivity bone lesions, a bone biopsy was obtained for final workup that confirmed the diagnosis of Paget disease (Figure 2).