Presentation
Initially in 2019-2020 years non-complaints, follow-up bone scan for a known prostatic cancer. Diffuse bone pain since 2021 year.
Patient Data
There is a single lesion with high Tc-99m diphosphonate uptake in the right scapula.
Metastatic osteoblastic lesion? Paget disease?
There is a sclerotic changes of the right scapular glenoid process.
It could be still sclerotic metastasis or Paget disease.
There is a new region with high Tc-99m diphosphonate uptake - second cervical vertebra. Enlargement of the scapular lesion.
Diffuse sclerotic changes with coarsened trabeculae of the scapula, coracoid, acromion processes, and posterior elements of C2 on the right with high Tc-99m MDP uptake.
The inferior part of the scapula lesion demonstrates spiculated periosteal reaction, suspicious for potential malignant changes.
Also seen a high Tc99m uptake in the region of the supraspinatus tendon, probable due to degenerative changes - subacromial impingement.
Multiple innumerous bone lesions consistent with metastatic progression.
Case Discussion
Patient underwent for a Radium-223 chloride systemic radiotherapy, unfortunately non-effective.
Initial imaging was concerning for Paget disease because of single sclerotic lesion of the right scapula in 2019 year.
In 2020 year the right scapular lesion was enlarged and new lesion of C2 vertebra was appeared.
In 2021 year follow-up bone scan revealed multiple bone lesions, so progressive metastatic disease confirmed.
This case illustrates an unusual distribution of metastatic lesions in prostate cancer, however, we're still cannot exclude a concomitant Paget disease of the right scapula.
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