Incidental Diagnosis of Metastatic Breast Cancer in a Man With 99mTc-PSMA SPECT/CT

Abstract

Breast cancer in men is a rare and unsuspected malignancy. A 48-year-old man begins with disabling low back pain. The CT scan reported a compression fracture in L2 and diffuse skeletal lesions suggestive of metastatic disease. The serum prostate-specific antigen was 6.2 ng/mL. He was referred for SPECT/CT with 99m Tc-EDDA/HYNIC-inhibitor prostate-specific membrane antigen due to clinical suspicion of prostate cancer. SPECT/CT with 99m Tc-EDDA/HYNIC-inhibitor prostate-specific membrane antigen showed a primary lesion in the left breast and multiple bone lesions. Biopsy confirmed infiltrating ductal carcinoma with positive hormone receptors and indeterminate HER2 (human epidermal growth factor receptor 2).

Diffuse Intense 18F-PSMA-1007 Uptake of the Breasts in a Woman With TFE3-Rearranged Renal Cell Carcinoma

“…PSMA uptake has been rarely reported in normal female breast and accessory breast tissues. This case indicated physiological PSMA uptake should be included in the differential diagnosis of abnormal breast or accessory breast PSMA activity, including breast cancer 16 and fibroadenoma 17…”

68Ga-PSMA-11 Uptake in a Large Fibroadenoma in a Male Axillary Accessory Breast

“…Physiological intense PSMA expression is seen in lacrimal, parotid, and submandibular glands, as well as small intestine, kidneys, liver, spleen, and bladder, whereas mild to moderate uptake in nasal and esophageal mucosa; the vocal cords, gallbladder, and biliary tract; tracheal and proximal bronchi; mediastinal, axillary, and inguinal lymph nodes; gynecomastia; and sympathetic ganglia, such as stellate, celiac, hypogastric, and presacral 2–4 . PSMA uptake has been mentioned in multiple oncological and nononcological lesions 5–7 . 68 Ga-PSMA-11 PET/CT showed higher sensitivity and similar specificity compared with MRI for metastatic lymph node detection in staging intermediate- or high-risk prostate cancer before radical prostatectomy 8 .…”