PMC5836149_01
A 65-year-old patient with pelvic node metastasis from prostate cancer. a Contrast-enhanced CT showing the left obturator node sized 8 x 8 mm (arrow). b Pelvic T2-weighted MRI showing the left obturator node sized 8 x 8 mm (arrow). c FDG-PET/CT showing faint FDG uptake (SUVmax: 1.95) in the 8-mm left obturator node (arrow). d11C-choline PET/CT showing moderate 11C-choline uptake (SUVmax: 4.16) in the 8-mm left obturator node (arrow).
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F1
Preoperative contrast-enhanced CT (Fig. 1a) and pelvic MRI (Fig. 1b) results showed mild swelling of the left obturator LN, which measured 8 x 8 mm. Pelvic MRI showed multiple hypointense areas in the bilateral prostate gland on T2-weighted images. Whole-body FDG-PET/CT scanning demonstrated mild FDG uptake in the left prostate zone, with faint FDG uptake with a maximum standardized uptake value (SUVmax) of 1.95 in the left obturator node (Fig. 1c). Subsequently, 11C-choline PET/CT scanning showed a strong accumulation of 11C-choline in the bilateral prostate gland and a moderate uptake of 11C-choline with an SUVmax value of 4.16 in the left obturator node (Fig. 1d).
Resected pelvic node metastasis. Histopathological findings of the left obturator node detected by 11C-choline PET/CT revealed invasion by prostate cancer cells.
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F2
PCa, with subtle extracapsular and seminal vesicle invasion. Pathological analysis of the LNs showed that 4 of 25 left obturator fossa LNs (Fig. 2), 2 of 13 left external iliac LNs, 1 of 5 left common iliac LNs, and 5 of 27 right obturator fossa LNs were metastatic.