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. 2023 Dec 1;7(1):26.
doi: 10.1186/s41824-023-00183-4.

Signet cell rectal carcinoma with prostatic involvement detected by FAPI-04 PET-MRI fusion

K Arun Prashanth  1 , Deepti Jain  2 , R Manikandan  3 , Suman Kalyan  4 , Vimalraj Velayutham  5 , R Surendran  5
Affiliations

Signet cell rectal carcinoma with prostatic involvement detected by FAPI-04 PET-MRI fusion

K Arun Prashanth et al. Eur J Hybrid Imaging. .

Abstract

A 60-year-old male patient diagnosed with mucinous adenocarcinoma of lower third of rectum underwent abdominoperineal resection and permanent colostomy followed by adjuvant chemotherapy. Response evaluation with F-18 FDG PET-CT showed a complete metabolic response. After 6 months, CEA levels started increasing and clinically a recurrence was suspected. A restaging FDG PET-CT showed no obvious malignant disease. Patient presented again within a month with complaints of urinary retention and haematuria. CEA levels were further elevated, and Ga-68 FAPI-04 (FAPI) PET-CT was performed. FAPI PET-CT revealed prostatic and seminal vesicle disease involvement. Additionally, an MRI of pelvis was done and fused with FAPI PET for confirmation of prostatic involvement.

Keywords: FAPI; FAPI MRI fusion; Fibroblast activation protein inhibitor PET-CT; Prostate secondaries; Rectal adenocarcinoma; Signet cell adenocarcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A FDG MIP, B MIP image of FAPI shows focus of uptake below the bladder (slender black arrow). C and D are axial fused images of FDG and FAPI PET-CT, respectively. The fused axial images of FAPI clearly show increased uptake (SUVmax-6.8) in prostate compared to FDG which shows only mild uptake. E H & E at 200× magnification image revealed normal prostate gland with corpora amylacea highlighted by blue arrows and tumour cells with signet ring morphology highlighted by bold black arrows, thus confirming the prostatic involvement by signet cell adenocarcinoma. F axial MRI and G FAPI MRI fusion images which show involvement of prostate. Seminal vesicles and base of bladder were also involved; (not shown H) contrast-enhanced diagnostic CT image which shows no significant abnormality
See this image and copyright information in PMC

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