Tl 99m Tc-MIBI 1 * * * * * 201 Tl 99m Tc-MIBI PSA ( ) 67 Ga PSA (490 ng/ml) (Bicalutamide) CT PSA PSA ( 40: , 2003) I. Whitmore 1) 2) 3

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1 Tl 99m Tc-MIBI 1 * * * * * 201 Tl 99m Tc-MIBI PSA ( ) 67 Ga PSA (490 ng/ml) (Bicalutamide) CT PSA PSA ( 40: , 2003) I. Whitmore 1) 2) 3) 4) 5) 6) * ( ) 201 Tl 99m Tc-MIBI 7,8) 99m Tc-MIBI 10) 67 Ga 10) 201 Tl 99m Tc-MIBI II. K. K cm, 61 kg 140/90

440 40 4 (2003) mmhg, 60/ Fig. 1 A whole-body 201 Tl scan showed multiple areas of abnormally increased radioactivity in both supraclavicular, anterior mediastinum, and bilateral hilar regions.

3 mg/dl, GOT; 23 IU/l, GPT; 27 IU/l, LDH; 351 IU/l, ALP; 145 IU/l, BUN; 15 mg/dl, Cr; 0.8 mg/dl, Na; 146 meq/l, K; 3.9 meq/l, Cl; 111 meq/l, Ca; 8.6 mg/dl, ACP; 1.8 KU, PRO-ACP 0.6 KU, CRP 3.4 mg/dl.

2 (2003) mmhg, 60/ Fig. 1 A whole-body 201 Tl scan showed multiple areas of abnormally increased radioactivity in both supraclavicular, anterior mediastinum, and bilateral hilar regions. WBC; /mm 3 (Neutro. 54%, Eos. 2%, Baso. 1%, Lymph. 36%, Mono. 7%). RBC; /mm 3, Hb; 12.3 g/dl Plt; /mm 3. Tp; 6.6 g/dl, T-Bil; 0.3 mg/dl, GOT; 23 IU/l, GPT; 27 IU/l, LDH; 351 IU/l, ALP; 145 IU/l, BUN; 15 mg/dl, Cr; 0.8 mg/dl, Na; 146 meq/l, K; 3.9 meq/l, Cl; 111 meq/l, Ca; 8.6 mg/dl, ACP; 1.8 KU, PRO-ACP 0.6 KU, CRP 3.4 mg/dl. FT 4; 1.15 ng/dl, T3; 0.89 ng/ ml, TSH; 3.21 µu/ml, ; 2.1 ng/ml. CEA; 1.0 ng/ml, SCC; 0.9 ng/ml, ; 0.6 ng/ml, NSE; 6.4 ng/ml, ProGRP; 15 pg/ ml, Calcitonin; 14 pg/ml, Tg; 10.4 ng/ml CRP 3.4 mg/dl Class I US 99m TcO Tl (Fig. 1) CT (Fig. 2-upper row) 67 Ga Fig. 2 Contrast-enhanced CT images (upper row) before and (lower row) 2 months after subcapsular orchiectomy and endocrine therapy. Transaxial CT slices of the neck, mediastinum and abdomen showed mutiple nodular lymphadenopathies (arrows). The same CT slices after treatment showed disappearance of previous abnormal lymphadenopathies.

accumulation in both supraclavicular fossa, anterior mediastinal, and both hilar areas.

Normal thyroids were seen on early images at 2 and 20 minutes and the thyroid uptake almost disappeared on delayed image at 120

3 201 Tl 99m Tc-MIBI Fig. 3 All selected images obtained at 2, 20, 60 and 120 minutes from a 99m Tc-MIBI scan showed symmetrical intense abnormal tracer accumulation in both supraclavicular fossa, anterior mediastinal, and both hilar areas. The cold lesion of left supraclavicular region might be caused by biopsy. Normal thyroids were seen on early images at 2 and 20 minutes and the thyroid uptake almost disappeared on delayed image at 120 minutes. Fig. 4 A 99m Tc-HMDP whole-body bone scan showed no bony metastases. Fig. 5 Immunohistochemical examination of a biopsy specimen of the mediastinal lymph node showed that the tumor cell were positive for PSA ( 50) CT m Tc-MIBI 201 Tl 99m Tc-MIBI (Fig. 3) Ca P PTH-intact 54 pg/ml 99m Tc-HMDP (Fig. 4) 5 27 PSA (Fig. 5) PSA PSA 490 ng/ml

442 40 4 (2003) 2) 201 Tl 99m Tc-MIBI 7,8) 201 Tl 99m Tc-MIBI 201 Tl Fig. 6 Microscopic examination of a transrectal needle biopsy specimen of the prostate revealed adenocarcinoma (H and E, 25).

4 (2003) 2) 201 Tl 99m Tc-MIBI 7,8) 201 Tl 99m Tc-MIBI 201 Tl Fig. 6 Microscopic examination of a transrectal needle biopsy specimen of the prostate revealed adenocarcinoma (H and E, 25). 7 2 (Fig. 6) bicalutamide 80 mg/day 8 26 PSA 2.5 ng/ml cut off 9 20 CT (Fig. 2-lower row) III. 201 Tl CT 67 Ga 99m Tc-MIBI 201 Tl PTH PSA stage 2 1) 99m Tc-MIBI 201 Tl 99m Tc-MIBI SPECT 2 CT PSA 5) PSA IV. 201 Tl 99m Tc-MIBI 1 PSA CT 1) Whitmore WF: The natural history of prostatic cancer. Cancer 1973; 32: ) Butler JJ, Howe CD, Johnson DE: Enlargement of the supraclavicular lymph nodes as the initial sign of prostatic carcinoma. Cancer 1971; 27: ) McMenamin PG, Anderson JD, Baker JJ: Prostatic carcinoma presenting with neck metastasis. J

5 201 Tl 99m Tc-MIBI Otolaryngol 1989; 18: ) Fletcher DR, Orell SR: Supraclavicular lymphadenopathy and carcinoma of the prostate. Med J Aust 1974; 2: ) Cho KR, Epstein JI: Metastatic prostatic carcinoma to supradiaphragmatic lymph nodes. A clinicopathologic and immunohistochemical study. Am J Surg Pathol 1987; 11: ) Saeterr G, Fossa SD, Ous S, Blom GP, Kaalhus O: Carcinoma of the prostate with soft tissue or nonregional lymphatic metastases at the time of diagnosis: a review of 47 cases. Br J Urol 1984; 56: ) : 1995; 32: ) Storey GR, Davies P, Cooper R: Tc-99m sestamibi uptake in metastatic prostate carcinoma. Clin Nucl Med 2000; 25: ) Wakasugi S, Hoguti A, Katsuda T, Hashizume T, Hasegawa Y: Potential of 99m Tc-MIBI for detecting bone marrow metastases. J Nucl Med 2002; 43: ) Makhija M: Metastatic prostatic carcinoma presenting as an anterior mediastinal mass on gallium imaging. Clin Nucl Med 1991; 16: Summary A Case Report of Distant Lymph Nodes Metastases from Prostate Cancer Imaged with 201 Tl and 99m Tc-MIBI Katsuji IKEKUBO, Megumu HINO, Hidetomi ITO, Hiroyuki OHTSUKA and Yasuhiko SAIKI Department of Nuclear Medicine, Kobe City General Hospital Prostate cancer most often metastases to regional lymph nodes and bones by hematogeneous or lymphatic spread. The authors present a rare case of metastatic prostate cancer to supradiaphragmatic lymph nodes that were detected on 201 Tl and 99m Tc-MIBI imaging and confirmed on a CT scan. An 81-yr-old man with bilateral painful cervical lymphadenopathies was referred to our hospital with suspected thyroid cancer. The US and thyroid scan indicated no abnormalities in his thyroid gland. Both 201 Tl and 99m Tc-MIBI scans showed multiple areas of abnormally increased radioactivity in both supraclavicular, anterior mediastinum, and bilateral hilar regions. A CT scan also revealed multiple lymphadenopathies in the same regions as radionuclide scans. Prostate cancer was diagnosed from the results of immunohistochemical staining for PSA examination of a biopsy specimen of the mediastinal lymph node. The serum PSA concentration was markedly elevated at 490 ng/ml (normal, 40 ng/ml). Both 99m Tc-HMDP bone and 67 Ga scans were normal. All supradiaphragmatic lymph nodes on CT images disappeared 2 months after subcapsular orchiectomy and endocrine treatment with Bicalutamide. Metastatic prostate cancer should be considered when metastatic adenocarcinoma is discovered in the supraclavicular lymph nodes of elder men. Key words: Prostate cancer, Supraclavicular lymph nodes metastases, 201 Tl, 99m Tc-MIBI, PSA.

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_06.indd 30, 35-39, 2010 0.15% 1 C 40 20 1 cm 5 mm WBC 9,400, RBC 259 10 4, Hb 8.5 g/dl, Ht 25.5%, Plt 29 10 4, BUN 116 mg/dl, Cr 7.9 mg/dl, 125 mg/dl, HbA1c 4.3%, ft3 1.97 pg/ml, ft4 1.05 ng/dl, TSH 1.09 μiu/ml,