Anaplastic thyroid carcinoma on 68 Ga-PSMA PET/CT: opening new frontiers

Excerpt

Prostate-Specific Membrane Antigen (PSMA) PET/CT has been extensively used in the management of patients with prostate cancer. This tracer also offers an important example of the concept of theranostics. However, PSMA expression has also been reported previously in other malignancies such as bladder, breast, gastric, colon, and lung cancers, as well as renal cell carcinoma, and in some non-neoplastic conditions [1‐7]. Few studies have shown expression of PSMA in thyroid cancer [8‐10]. To the best of our knowledge this is the first report of intense PSMA expression in anaplastic thyroid carcinoma (ATC). It is well known from some earlier studies that PSMA expression is seen in the endothelium of tumor neovasculature where there is abnormal protein expression and increased transcription of PSMA through activation of the transcriptional enhancer region in endothelial cells. PSMA expression may be seen in ATCs since they have very high vascularity. In this case, PSMA PET/CT showed high uptake in the primary tumor, cervical and mediastinal nodes (Fig. 1). The uptake was most intense in the periphery of the tumor concordant with the expected distribution of neovasculature. The patient also had multiple tiny nodules in bilateral lungs, but uptake was not discernible, possibly because of small size. This may open up a new possible therapeutic option for using ¹⁷⁷ Lu-PSMA-DKFZ-617 therapy to treat ATC.

…