Pleural Hemangioma Detected by 18F-PSMA PET/CT in High-Risk Prostate Cancer Staging: A Case Report and Review of the Literature

Prostate cancer (PCa) staging has advanced significantly with the emergence of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT). However, PSMA-labeled radiotracers uptake is not exclusive to PCa, leading to potential pitfalls. We report an unusual case of a 71-year-old man with high-risk PCa undergoing initial staging with PET/CT using 18F-labeled PSMA (18F-PSMA), which revealed an unexpected uptake in a pleural nodular lesion. Given the extreme rarity of PCa pleural metastases, an excisional biopsy of the lesion was performed. Histopathological analysis confirmed the diagnosis of a pleural lobular capillary hemangioma, a benign vascular tumor extremely rare in this location. This case represents the first documented instance of PSMA radiopharmaceutical uptake in a pleural hemangioma, expanding the spectrum of known PSMA PET/CT pitfalls. This finding underscores the importance of histopathological confirmation for atypical PSMA PET/CT findings in unusual locations, preventing incorrect staging and avoiding inappropriate therapeutic decisions.