68 Ga-PSMA Scintigraphy of Cervicothoracic Ganglioneuroma

We present a case illustrating a diagnostic pitfall on 68 Ga-PSMA PET/CT in a 67-year-old man with newly diagnosed prostate adenocarcinoma (Gleason score 4 + 3). Staging imaging demonstrated a solitary, distant PSMA-avid focus at the thoracic inlet. The lesion's characteristic paravertebral location, consistent with the stellate ganglion, favored a non-prostate cancer-related etiology; however, the marked intensity of radiotracer uptake was more suggestive of metastatic disease. Histopathologic evaluation confirmed a ganglioneuroma. This case underscores that ganglioneuromas may exhibit high PSMA avidity and should be recognized to prevent false-positive interpretation on PSMA-targeted imaging.