www.nuclmed.gr Hellenic Journal of Nuclear Medicine ñ January - April 2008 Correspondence 55 To the Editor: Metastatic prostate carcinoma (PC) may not only present without increased serum levels of prostate specific antigen, as we have reported in a letter published in the present issue of HJNM, but it may also present as a solitary clavicle metastasis. Such a case we describe in this letter as follows: A 67 year old retired married male worker, with diagnosed PC had undergone 3-dimensional conformal radiotherapy 3 years ago. He also received subcutaneously 10.8 mg of depot gosere- lin acetate every 3 months. The prostate specific antigen (PSA) serum level was 0.003 ng/ml (normal: <4 ng/ml). He was re- ferred to our department for bone scintigraphy because of ster- nal pain. He had no previous trauma or traffic accident. Whole body bone scintigraphy was obtained after the intravenous in- jection of 740 MBq of technetium-99m methylene diphospho- nate ( 99m Tc-MDP) using a dual-head gamma camera interfaced with a dedicated computer (Siemens E.CAM, Siemens Medical Systems, Inc. Hoffman Estates, IL 60195, USA). Anterior scan image revealed markedly increased uptake in the left clavicle (Fig. 1). In the posterior scintigraphic image, slightly increased uptake was seen in the thoracolumbar verte- brae. Multidetector computed tomography showed a lytic and sclerotic region in the left clavicle compatible with metastasis (Fig. 2). A biopsy from this lesion showed PC (Fig. 3). Magnetic resonance imaging revealed degenerative changes in this area. Metastases of PC in the skeleton are usually multiple. Re- view of the literature reveals that solitary metastasis from prostate carcinoma is rare. Only a few cases have been reported previously but there is no report of the clavicle being the site of a PC solitary metastasis [1-6]. Acknowledgment We would like to thank M.D. Umran Yildirim for the histo- pathology examination. Bibliography 1. Barkow U, Weissbach L, Strohmeier A et al. Solitary metastasis of prostate cancer in the tibia. Aktuelle Radiol 1994; 5: 274-276. 2. Sciuk J, Kirchner B. Atypical bone metastases in prostate cancer. Aktuelle Radiol 1991; 3: 134-137. 3. Fioretta G, Rotolo F, Zanasi S. Solitary bony metastasis of undifferentiat- ed carcinoma of the prostate to the cervical spine. Chir Organi Mov 1981; 1: 115-120. 4. Kwee IL, Nakada T, St John JN. Triple fossa metastasis of prostate cancer. Neurosurgery 1983; 5: 584-586. 5. Ansari MS, Nabi G, Aron M. Solitary radial head metastasis with wrist drop: a rare presentation of metastatic prostate cancer. Urol Int 2003; 1: 77-79. 6. Reigman HI, Stokkel MP. Peripheral bone metastases in prostate cancer: a rare localization at initial presentation. Clin Nucl Med 2004; 5: 335-336. Bedri Seven, M.D. 1 , Erhan Varoglu, M.D. 1 , Kerim Cayir, M.D. 2 , Salim Basol Tekin, M.D. 2 1. Department of Nuclear Medicine and 2. Department of Internal Medicine of Ataturk University, Medical School, Erzurum, Turkey Bedri Seven, M.D. Department of Nuclear Medicine, Ataturk University, Medical School, 25240, Erzurum, Turkey Phone: 90-442-2360900, Fax: 90-442-2312766 E-mail: [email protected], [email protected] [ Solitary clavicle metastasis in prostate carcinoma Figure 1. Anterior and posterior whole body bone scintigraphy revealed atypical intense uptake in the left clavicle. Figure 2. (A) Axial and (B) coronal multidetector computed tomography images show lytic and sclerotic regions in the expanded left clavicle compatible with metastasis (white arrows). Figure 3. Metastatic prostate carcinoma nests near the exhibiting osteoblastic activity, surround bone fragment (hematoxylin-eosin x10).

Solitary clavicle metastasis in prostate carcinoma M …5. Ansari MS, Nabi G, Aron M. Solitary radial head metastasis with wrist drop: a rare presentation of metastatic prostate cancer

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Page 1: Solitary clavicle metastasis in prostate carcinoma M …5. Ansari MS, Nabi G, Aron M. Solitary radial head metastasis with wrist drop: a rare presentation of metastatic prostate cancer

www.nuclmed.gr Hellenic Journal of Nuclear Medicine ñ January - April 2008

Correspondence

C MYK C MYK

To the Editor: Metastatic prostate carcinoma (PC) may notonly present without increased serum levels of prostate specif-ic antigen, as we have reported in a letter published in the pre-sent issue of HJNM, but it may also present as a solitary claviclemetastasis. Such a case we describe in this letter as follows: A67 year old retired married male worker, with diagnosed PChad undergone 3-dimensional conformal radiotherapy 3 yearsago. He also received subcutaneously 10.8 mg of depot gosere-lin acetate every 3 months. The prostate specific antigen (PSA)serum level was 0.003 ng/ml (normal: <4 ng/ml). He was re-ferred to our department for bone scintigraphy because of ster-nal pain. He had no previous trauma or traffic accident. Wholebody bone scintigraphy was obtained after the intravenous in-jection of 740 MBq of technetium-99m methylene diphospho-nate (99mTc-MDP) using a dual-head gamma camera interfacedwith a dedicated computer (Siemens E.CAM, Siemens MedicalSystems, Inc. Hoffman Estates, IL 60195, USA).

Anterior scan image revealed markedly increased uptake inthe left clavicle (Fig. 1). In the posterior scintigraphic image,slightly increased uptake was seen in the thoracolumbar verte-brae. Multidetector computed tomography showed a lytic andsclerotic region in the left clavicle compatible with metastasis(Fig. 2). A biopsy from this lesion showed PC (Fig. 3). Magneticresonance imaging revealed degenerative changes in this area.

Metastases of PC in the skeleton are usually multiple. Re-view of the literature reveals that solitary metastasis fromprostate carcinoma is rare. Only a few cases have been re-ported previously but there is no report of the clavicle beingthe site of a PC solitary metastasis [1-6].

AcknowledgmentWe would like to thank M.D. Umran Yildirim for the histo-pathology examination.

Bibliography1. Barkow U, Weissbach L, Strohmeier A et al. Solitary metastasis of

prostate cancer in the tibia. Aktuelle Radiol 1994; 5: 274-276.

2. Sciuk J, Kirchner B. Atypical bone metastases in prostate cancer. AktuelleRadiol 1991; 3: 134-137.

3. Fioretta G, Rotolo F, Zanasi S. Solitary bony metastasis of undifferentiat-ed carcinoma of the prostate to the cervical spine. Chir Organi Mov1981; 1: 115-120.

4. Kwee IL, Nakada T, St John JN. Triple fossa metastasis of prostate can-cer. Neurosurgery 1983; 5: 584-586.

5. Ansari MS, Nabi G, Aron M. Solitary radial head metastasis with wrist drop:a rare presentation of metastatic prostate cancer. Urol Int 2003; 1: 77-79.

6. Reigman HI, Stokkel MP. Peripheral bone metastases in prostate cancer: arare localization at initial presentation. Clin Nucl Med 2004; 5: 335-336.

Bedri Seven, M.D.1, Erhan Varoglu, M.D.1, Kerim Cayir, M.D.2,Salim Basol Tekin, M.D.2

1. Department of Nuclear Medicine and 2. Department of InternalMedicine of Ataturk University, Medical School, Erzurum, Turkey

Bedri Seven, M.D.Department of Nuclear Medicine, Ataturk University,Medical School, 25240, Erzurum, TurkeyPhone: 90-442-2360900, Fax: 90-442-2312766 E-mail: [email protected], [email protected] [

Solitary clavicle metastasis in prostate carcinoma

Figure 1. Anterior and posterior whole body bone scintig-raphy revealed atypical intense uptake in the left clavicle.

Figure 2. (A) Axial and (B) coronal multidetector computed tomographyimages show lytic and sclerotic regions in the expanded left claviclecompatible with metastasis (white arrows).

Figure 3.Metastatic prostatecarcinoma nestsnear the exhibitingosteoblasticactivity, surroundbone fragment(hematoxylin-eosinx10).