Endocrinol Metab.  2010 Dec;25(4):365-369. 10.3803/EnM.2010.25.4.365.

A Case of Residual Medullary Thyroid Carcinoma Detected by 18F-FDG-PET/CT in Patient with Persistent Hypercalcitoninemia

Affiliations
  • 1Department of Endocrinology and Metabolism, Soonchunhyang University Hospital, Seoul, Korea. chkim@schmc.ac.kr
  • 2Department of Pathology, Soonchunhyang University Hospital, Seoul, Korea.

Abstract

Medullary thyroid carcinoma (MTC) is a rare and challenging malignancy. In patients with residual MTC, the tumor detection rate is generally low for most of the currently available imaging techniques. Various imaging methods have already been used for the detection of residual tumor, but no modality has been shown to be superior to others. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been proposed to identify residual MTC, but this procedure also has limitations as small masses are rarely detected. So, a multimodality imaging approach is recommended for detecting residual MTC. We report here on a case of residual MTC that was detected by 18F-FDG PET/CT in a patient with persistent hypercalcitoninemia after total thyroidectomy and bilateral lymph node dissection.

Keyword

Meduallary carcinoma; Calcitonin; Positron-Emission Tomography

MeSH Terms

Calcitonin
Electrons
Fluorodeoxyglucose F18
Humans
Lymph Node Excision
Neoplasm, Residual
Positron-Emission Tomography
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Calcitonin
Fluorodeoxyglucose F18

Figure

  • Fig. 1 Cut surface of the thyroid gland. An ovoid well encapsulated gray white solid nodule, measuring 1.8 cm in diameter, is seen in the right lobe.

  • Fig. 2 Microscopic findings of the thyroid gland mass. (A) Thick trabeculae or nests of rare atypical polygonal cells are seen without areas of follicular arrangement (H&E, × 40). (B) Tumor cells have eccentric nuclei with finely stippled chromatin and abundant eosinophilic granular cytoplasm (H&E, × 400).

  • Fig. 3 18F-FDG PET/CT. The 18F-FDG PET/CT shows increased uptake in right cervical lymph node.

  • Fig. 4 Fine needle aspiration cytology of neck mass. Loose clusters of or individual tumor cells with eccentric nuclei and marked anisonucleosis are found (H&E, × 200).

  • Fig. 5 Microscopic findings of neck mass. (A) The nodal architecture is mostly destroyed by metastasis of large atypical tumor cells resembling the original thyroid mass (H&E, × 40). (B) Tumor cells are strongly positive for calcitonin (immunohistochemistry for calcitonin, × 200).


Reference

1. Fernandez Vila JM, Peix JL, Mandry AC, Mezzadri NA, Lifante JC. Biochemical results of reoperations for medullary thyroid carcinoma. Laryngoscope. 2007. 117:886–889.
2. Fialkowski E, DeBenedetti M, Moley J. Long-term outcome of reoperations for medullary thyroid carcinoma. World J Surg. 2008. 32:754–765.
3. Weber T, Klar E. Minimal residual disease in thyroid carcinoma. Semin Surg Oncol. 2001. 20:272–277.
4. Szakáll S Jr, Esik O, Bajzik G, Repa I, Dabasi G, Sinkovics I, Agoston P, Trón L. 18F-FDG PET detection of lymph node metastases in medullary thyroid carcinoma. J Nucl Med. 2002. 43:66–71.
5. Nanni C, Rubello D, Fanti S, Farsad M, Ambrosini V, Rampin L, Banti E, Carpi A, Muzzio P, Franchi R. Role of 18F-FDG-PET and PET/CT imaging in thyroid cancer. Biomed Pharmacother. 2006. 60:409–413.
6. Giraudet AL, Vanel D, Leboulleux S, Aupérin A, Dromain C, Chami L, Ny Tovo N, Lumbroso J, Lassau N, Bonniaud G, Hartl D, Travagli JP, Baudin E, Schlumberger M. Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels. J Clin Endocrinol Metab. 2007. 92:4185–4190.
7. Ong SC, Schöder H, Patel SG, Tabangay-Lim IM, Doddamane I, Gönen M, Shaha AR, Tuttle RM, Shah JP, Larson SM. Diagnostic accuracy of 18F-FDG PET in restaging patients with medullary thyroid carcinoma and elevated calcitonin levels. J Nucl Med. 2007. 48:501–507.
8. Rubello D, Rampin L, Nanni C, Banti E, Ferdeghini M, Fanti S, Al-Nahhas A, Gross MD. The role of 18F-FDG PET/CT in detecting metastatic deposits of recurrent medullary thyroid carcinoma: a prospective study. Eur J Surg Oncol. 2008. 34:581–586.
9. Schott M, Willenberg HS, Sagert C, Nguyen TB, Schinner S, Cohnen M, Cupisti K, Eisenberger CF, Knoefel WT, Scherbaum WA. Identification of occult metastases of medullary thyroid carcinoma by pentagastrin-stimulated intravenous calcitonin sampling followed by targeted surgery. Clin Endocrinol(Oxf). 2007. 66:405–409.
10. Ball DW. Medullary thyroid cancer: monitoring and therapy. Endocrinol Metab Clin North Am. 2007. 36:823–837.
11. Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA Jr. American Thyroid Association Guidelines Task Force. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009. 19:565–612.
12. Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg. 1999. 229:880–887.
13. Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002. 26:22–28.
14. Franc S, Niccoli-Sire P, Cohen R, Bardet S, Maes B, Murat A, Krivitzky A, Modigliani E. French Medullary Study Group (GETC). complete surgical lymph node resection does not prevent authentic recurrences of medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2001. 55:403–409.
15. Koopmans KP, de Groot JW, Plukker JT, de Vries EG, Kema IP, Sluiter WJ, Jager PL, Links TP. 18F-dihydroxyphenylalanine PET in patients with biochemical evidence of medullary thyroid cancer: relation to tumor differentiation. J Nucl Med. 2008. 49:524–531.
16. Rendl G, Manzl M, Hitzl W, Sungler P, Pirich C. Long-term prognosis of medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2008. 69:497–505.
17. Simon GH, Nitzsche EU, Laubenberger JJ, Einert A, Moser E. PET imaging of recurrent medullary thyroid cancer. Nuklearmedizin. 1996. 35:102–104.
Full Text Links
  • ENM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr