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Bone Metastasis with Superimposed Osteomyelitis in Prostate Cancer

University Clinics of Nuclear Medicine, Maxillofacial Surgery, Radiology and Clinical Pathology, Vienna, Austria

Correspondence: For correspondence or reprints contact: Martha Pruckmayer, MD, University Clinic of Nuclear Medicine, General Hospital Vienna, Leitstelle 3L, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

ABSTRACT

The following case of a male patient with a history of prostate cancer suffering from pain and swelling in the right mandibular area illustrates the well-known diagnostic problem of a superinfected tumor. Orthopan tomography and CT showed no defects in bone structure or smooth tissue. Whole-body bone scanning showed increased tracer uptake in the mandibular bone and in several other locations in the skeletal system. Antigranulocyte immunoscintigraphy showed increased uptake over the right mandible, whereas the other metastatic sites were visualized as cold spots. A second CT scan depicted a sclerotic lesion with surrounding periostal reaction and soft-tissue swelling and was interpreted as osteomyelitis. Therefore, clinical symptoms, bone scanning, antigranulocyte immunoscintigraphy and follow-up CT resulted in a diagnosis of osteomyelitis, although open needle biopsy revealed the lesion to be prostate cancer metastasis with massive leukocytic invasion.

Key Words: antigranulocyte immunoscintigraphy • prostate cancer • bone metastases • SPECT

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				D Schulze, M Blessmann, P Pohlenz, K. Wagner, and M Heiland Diagnostic criteria for the detection of mandibular osteomyelitis using cone-beam computed tomography. Dentomaxillofac. Radiol., July 1, 2006; 35(4): 232 - 235. [Abstract] [Full Text] [PDF]