Fig. 4
From: PSMA expression level predicts differentiated thyroid cancer aggressiveness and patient outcome
Example of PSMA staining in an 80-year-old female diagnosed with a poorly differentiated thyroid cancer (presence of vascular invasion, free surgical margins, pT3mpN1acM1 – stage IVb). Panoramic view (a, × 2) shows the insular pattern of growth highlighted by PSMA staining which involves endothelial cells almost completely (b, × 20) and was quantified as 80%. Staging PET/CT image (c) shows [18F]FDG uptake in the left lobe of thyroid, cervical, and mediastinal lymph nodes, lungs, and liver. Diagnostic whole-body scan (185 MBq) obtained 3 months after thyroidectomy shows several foci of radioiodine (RAI) uptake in the mediastinum, lungs, and liver (d). Images (e) obtained after RAI treatment (5550 MBq) show uptake in mediastinum, lungs (fewer lesions than on the diagnostic scan), and liver. Accordingly, the patient was defined as RAI refractory. Clinical evidence of disease progression occurred 5 months after treatment (thyroglobulin 2864 ng/mL) as confirmed by PET/CT images showing the appearance of new lung lesions (f). At last follow-up (26 months after RAI treatment), the patient presented rapidly clinical progressive disease and palliative therapies were commenced