Pitfalls in Ga-68-PSMA-PET/CT: incidental finding of parathyroid adenoma

  • Christian H. PfobEmail author
  • Ilham Karimov
  • Moritz Jesinghaus
  • Alexander Novotny
  • Wolfgang A. Weber
  • Matthias Eiber
  • Benedikt Feuerecker
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Imaging using prostate-specific membrane specific antigen (PSMA) PET/CT has shown its potential in initial diagnostic and staging of prostate cancer. PSMA is highly overexpressed in most prostate cancers, but other malignancies such as lung cancer, colon, gastric, thyroid and renal cancer have been reported to express PSMA and have been reported as incidental findings on PSMA PET/CT scans [1, 2, 3]. Here we report an incidental finding of a patient with prostate adenocarcinoma and biochemical recurrence (PSA 0.15 ng/ml) who underwent a Ga-68-PSMA-PET/CT. The scan showed focal uptake dorsally to the right thyroid gland, at the typical location of the parathyroid gland (a PET only, b fused PET/CT, arrows indicate the lesion). The patient was referred to surgery to remove this lesion. Preoperatively, serum calcium (2.93 mmol/l; normal range 2.20–2.65 mmol/l) and parathyroid hormone (445.7 pg/ml; normal range 15–65 pg/ml) were elevated. Post-operative histology showed a parathyroid adenoma (c positive parathyroid hormone staining, d HE staining) and parathyroid hormone and serum calcium decreased after surgery. PSMA was mainly expressed in small intraparathyrodial blood vessels / capillaries (e arrows). This is in line with previous reports showing expression of PSMA in highly vascular regions [4, 5]. Parathyroid adenoma should be included in the differential diagnosis of focal tracer uptake on PSMA PET-CT.


  1. 1.
    Pyka T, Weirich G, Einspieler I, Maurer T, Theisen J, Hatzichristodoulou G, et al. 68Ga-PSMA-HBED-CC PET for differential diagnosis of suggestive lung lesions in patients with prostate cancer. J Nucl Med. 2016;57:367–71. Scholar
  2. 2.
    Verburg FA, Krohn T, Heinzel A, Mottaghy FM, Behrendt FF. First evidence of PSMA expression in differentiated thyroid cancer using [(6)(8)Ga]PSMA-HBED-CC PET/CT. Eur J Nucl Med Mol Imaging. 2015;42:1622–3. Scholar
  3. 3.
    Kinoshita Y, Kuratsukuri K, Landas S, Imaida K, Rovito PM Jr, Wang CY, et al. Expression of prostate-specific membrane antigen in normal and malignant human tissues. World J Surg. 2006;30:628–36. Scholar
  4. 4.
    Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res. 1997;3:81–5.Google Scholar
  5. 5.
    Liu H, Moy P, Kim S, Xia Y, Rajasekaran A, Navarro V, et al. Monoclonal antibodies to the extracellular domain of prostate-specific membrane antigen also react with tumor vascular endothelium. Cancer Res. 1997;57:3629–34.Google Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nuclear MedicineTechnische Universität München, Klinikum rechts der IsarMunichGermany
  2. 2.Department of PathologyTechnische Universität München, Klinikum rechts der IsarMunichGermany
  3. 3.German Cancer Consortium (DKTK), partner site München; and German Cancer, Research Center (DKFZ)HeidelbergGermany
  4. 4.Department of SurgeryTechnische Universität München, Klinikum rechts der IsarMunichGermany

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