Table 1. Chronologic summary of events in the work-up of the patient's lumbar spine lesions, with the approximate amount of time since the patient's prostate cancer was originally diagnosed. Where applicable, values represent the largest axial×coronal×sagittal dimensions.
aBone scan refers specifically to technetium pyrophosphate nuclear scintigraphy.
bLaboratory panel included total prostate-specific antigen, thyroid panel, immunofixation electrophoresis, complete blood count with differential, and comprehensive metabolic panel.
CT: computed tomography; 18F-FDG PET-CT: 18 fluorine fluorodeoxyglucose positron emission tomography-CT; FNA: fine-needle aspiration; CNB: core needle biopsy; BMA: bone marrow aspiration
| Diagnostic modality | Elapsed time since cancer diagnosis (April 2019) | Findings |
| Non-contrast CT of the lumbar spine | 31 months | New hypodense L5 lesion measuring 18.7×12.6×12 mm (see Figure 2) |
| Bone scana | 32 months | Mildly increased uptake in the left side of L5 corresponding to the lesion seen on CT (see Figure 3A) |
| 18F-FDG PET-CT | 33 months | Mildly hypermetabolic L5 lesion corresponding to the lesion seen on CT (see Figure 4) |
| CT-guided FNA | 33.5 months | Fibrin, scattered inflammatory cells, and no neoplastic findings |
| Non-contrast CT of the lumbar spine | 47 months | Marked interval expansion of the hypodense L5 lesion, now measuring 30.4×22.6×13.8 mm; new hypodense L4 lesion measuring 4×13.9×4.3 mm (see Figure 6) |
| Bone scana | 47 months | Increased uptake in the left side of L5, stable from prior exam; mildly increased uptake in the inferior margin of L4, adjacent to the L5 lesion (see Figure 3B) |
| CT-guided FNA | 47.5 months | Non-diagnostic specimen |
| CT-guided CNB | 47.5 months | Fibrous tissue, benign bone, and no neoplastic findings |
| CT-guided BMA | 47.5 months | No evidence of clonality |
| Laboratory panelb | 48.5 months | Within normal limits |
| CT-guided CNB | 49 months | Benign bone remodeling and fibrocartilage; bacterial and fungal cultures of this specimen demonstrated no growth |
| Open biopsy | 50 months | Benign-appearing disorganized fibrocartilage, consistent with Schmorl’s node (see Figure 7) |