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68Ga PSMA Uptake at Roux-en-Y Eso-jejunostomy Junction Mimicking the Recurrence of Gastric Carcinoma in PET/CT


  • Esra Arslan
  • Tamer Aksoy
  • Merve Cin
  • Coşkun Çakır
  • Fadime Didem Can Trabulus
  • Tevfik Fikret Çermik

Received Date: 10.11.2019 Accepted Date: 02.04.2020 Mol Imaging Radionucl Ther 2021;30(1):63-66

A 67-year-old male patient had undergone total gastrectomy and Roux-en-Y eso-jejunostomy 3 years ago for the treatment of tubular adenocarcinoma located at the corpus of the stomach. The patient was diagnosed with Gleason score 8 (4+4) metastatic prostate cancer during the follow-up period and received hormone therapy. Owing to his elevated prostate-specific antigen levels (77 ng/mL), his clinician referred him gallium-68 (68Ga) prostate-specific membrane antigen 11 (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT showed multiple 68Ga PSMA receptor-positive skeletal lesions and linear PSMA activity at the eso-jejunostomy junction. He was then referred to undergo 18fluorine-fluorodeoxyglucose (18F-FDG) PET/CT to screen for gastric carcinoma recurrence. PET/CT images demonstrated no 18F-FDG avid lesion. However, endoscopy and biopsy performed with samples from the eso-jejunostomy junction revealed superficial benign squamous epithelial fragments.

Keywords: 68Ga-PSMA, 18F-FDG, PET/CT, gastric carcinoma, prostate carcinoma


Informed Consent: The patient was asked for the verbal or written consent for the use of the individual clinical findings for research purposes.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: C.Ç., F.D.C.T, M.C., Concept: E.A., T.F.Ç., Design: E.A., T.F.Ç., T.A., Data Collection or Processing: E.A., T.F.Ç., T.A., Analysis or Interpretation: E.A., T.F.Ç., T.A, C.Ç., F.D.C.T, M.C., Literature Search: E.A., T.F.Ç., T.A., Writing: E.A., T.F.Ç., T.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


  1. Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, Holland-Letz T, Giesel FL, Kratochwil C, Haufe S, Haberkorn U, Zechmann CM. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 2013;40:486-495.
  2. Demirci E, Sahin OE, Ocak M, Akovali B, Nematyazar J, Kabasakal L. Normal distribution pattern and physiological variants of 68Ga-PSMA-11 PET/CT imaging. Nucl Med Commun 2016;37:1169-1179.
  3. Kirchner J, Schaarschmidt BM, Sawicki LM, Heusch P, Hautzel H, Ermert J, Rabenalt R, Antoch G, Buchbender C. Evaluation of Practical Interpretation Hurdles in 68Ga-PSMA PET/CT in 55 Patients: Physiological Tracer Distribution and Incidental Tracer Uptake. Clin Nucl Med 2017;42:322-327.
  4. Hofman MS, Hicks RJ, Maurer T, Eiber M. Prostate-specific Membrane Antigen PET: Clinical Utility in Prostate Cancer, Normal Patterns, Pearls, and Pitfalls. Radiographics 2018;38:200-217.
  5. Holderman WH, Jacques JM, Blackstone MO, Brasitus TA. Prostate cancer metastatic to the stomach. Clinical aspects and endoscopic diagnosis. J Clin Gastroenterol 1992;14:251-254.
  6. Solis Lara HE, Villarreal Del Bosque N, Sada Treviño MA, Yamamoto Ramos M, Argueta Ruiz RDC. Gastric Metastasis of Prostate Cancer as an Unusual Presentation Using 68Ga-Prostate-Specific Membrane Antigen PET/CT. Clin Nucl Med 2018;43:156-159.
  7. Onitilo AA, Engel JM, Resnick JM. Prostate carcinoma metastatic to the stomach: report of two cases and review of the literature. Clin Med Res 2010;8:18-21.
  8. Hong KP, Lee SJ, Hong GS, Yoon H, Shim BS. Prostate cancer metastasis to the stomach. Korean J Urol 2010;51:431-433.
  9. Shetty D, Patel D, Le K, Bui C, Mansberg R. Pitfalls in Gallium-68 PSMA PET/CT Interpretation-A Pictorial Review. Tomography 2018;4:182-193.
  10. Gordon IO, Tretiakova MS, Noffsinger AE, Hart J, Reuter VE, Al-Ahmadie HA. Prostate-specific membrane antigen expression in regeneration and repair. Mod Pathol 2008;21:1421-1427.