Ossifying hepatic metastases from prostatic carcinoma

Case contributed by Dr. Chris O'Donnell

Presentation

Known prostate malignancy with rapidly rising PSA. CT and bone scan staging prior to chemotherapy.

Patient Data

Age: 70
Gender: Male

Multiple hyperdense masses throughout the liver with low density rims.

The differential is between calcification and contrast enhancement.

Tc99MDP bone scan as part of the staging process

Nuclear medicine

Patchy accumulation of tracer in the liver at the site of hyperdense masses on CT (confirmed on the SPECT imaging) indicating the presence of osteoclasts.  Note no abnormal isotope accumulation in the bones.

Case Discussion

Calcified liver metastases are reasonably uncommon and usually associated with metastatic mucinous adenocarcinoma (gastric or colonic in origin).  Prostatic metastases are typically sclerotic in bone, but very rarely calcified in soft tissues although it has been reported (see below).  Given the positivity on nuclear bone scan, these lesions are not just calcified but actively ossifying. The effect is a primary phenomenon and not post-chemotherapy as the patient has not yet received any such treatment.

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