Correspondence
A rare case of solitary subcutaneous scalp metastasis from follicular thyroid carcinoma revealed with positron emission tomography/computed tomography: A case report and review ABSTRACT Differentiated thyroid cancer frequently metastasizes to regional cervical lymph nodes and in advanced cases metastases can be seen in the lungs and skeleton. Metastases to the skin or subcutaneous tissue are rare. Here we present a 49‑year‑old female patient with solitary scalp metastasis from follicular thyroid carcinoma FTC which was revealed with positron emission tomography (PET)/ computed tomography (CT) imaging. PET showed flourodeoxiglucose avid lesion in the left vertex scalp. Scalp lesion was removed totally and histopathological examination revealed well‑differentiated thyroid cancer metastasis. KEY WORDS: Follicular thyroid carcinoma, positron emission tomography/computed tomography scalp metastasis
INTRODUCTION Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer which is considered more aggressive than papillary carcinoma. Vascular invasion is characteristic for follicular carcinoma and therefore distant metastasis is more common. FTC can metastasize to lungs, bones, and brain via hematogenous spread.[1] Scalp is an uncommon site for metastasis and which is extremely rare.[2] Metastatic tumors to the scalp are most often from lung, breast, and prostate malignancies and rarely from thyroid cancers.[3] In this case, a 49‑year‑old patient with solitary scalp metastasis from follicular thyroid cancer was presented. The aim if this study was to discuss the imaging and therapy choice of scalp metastases of FTC and alsoto remind that follicular thyroid cancer can metastasize to the scalp. CASE REPORT A 49‑year‑old female patient admitted to hospital with bulging on the left vertex of the scalp. Patient had a subtotal thyroidectomy history 4‑year ago and diagnosed with minimally invasive follicular thyroid cancer which was 0.9 cm in diameter. Radioactive iodine therapy was not given because of tumor size after the operation. Patient did not
come to the hospital for follow‑up examinations and blood test after this period. She was admitted to neurosurgery polyclinic because of bulging on the left side of vertex. She was referred to positron emission tomography (PET)/computed tomography (CT) examination for the evaluation of flourodeoxiglucose (FDG) uptake of this lesion to determine the biopsy side and also to search for the other possible metastases. PET/CT whole‑body imaging was performed after intravenous injection of 420 MBq (11.35 mCi) Flouro‑18 FDG. After 1 h of waiting period in a silent room, the patient was imaged using an integrated PET/CT camera, which was consisted of a six‑slice CT gantry, integrated with a lutetium oxyorthosilicate (LSO) based full‑ring PET scanner (Siemens Bio‑graph 6, IL, Chicago, USA). PET/CT images showed intense FDG uptake on the left vertex of the scalp with a soft‑tissue component on CT slices with a maximum standard uptake value of (SUVmax) 9.8 [Figure 1]. Pathological FDG uptake was not seen on the thyroid bed, cervical regions, and on the skeletal system. After the PET/ CT imaging, excisional biopsy was performed. Histopathological examination revealed a FTC metastasis [Figure 2]. After the operation, patient was referred to the nuclear medicine department for radioactive iodine therapy. High‑dose I‑131 was
Journal of Cancer Research and Therapeutics - April-June 2014 - Volume 10 - Issue 2
Sait Sager, Sabire Yilmaz, Rana Kaya Doner, Mutlu Niyazoglu1, Metin Halac, Bedii Kanmaz Departments of Nuclear Medicine, and 1Endocrinology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey For correspondence: Dr. Sait Sager, Department of Nuclear Medicine, Istanbul University, Cerrahpasa Medical Faculty, Cerrahpasa, Fatih, Istanbul, Turkey. E‑mail: saitsager@ yahoo.com
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.136681 PMID: *** Quick Response Code:
431
Sager, et al.: Solitary scalp metastasis of follicular thyroid carcinoma
Figure 1: Selected coronal, axial and sagittal positron emission tomography/ computed tomography and fusion images showed incresed flourodeoxiglucose uptake on the left vertex of scalp with SUVmax of 9.8
given and whole body I‑131 imaging was performed 3 days after the therapy which showed focal uptake on thyroid bed [Figure 3]. Six months after the radioactive iodine therapy, low dose I‑131 whole‑body image was evaluated as normal and the patient’s thyroglobulin levels were
A rare case of solitary subcutaneous scalp metastasis from follicular thyroid carcinoma revealed with positron emission tomography/computed tomography: A case report and review ABSTRACT Differentiated thyroid cancer frequently metastasizes to regional cervical lymph nodes and in advanced cases metastases can be seen in the lungs and skeleton. Metastases to the skin or subcutaneous tissue are rare. Here we present a 49‑year‑old female patient with solitary scalp metastasis from follicular thyroid carcinoma FTC which was revealed with positron emission tomography (PET)/ computed tomography (CT) imaging. PET showed flourodeoxiglucose avid lesion in the left vertex scalp. Scalp lesion was removed totally and histopathological examination revealed well‑differentiated thyroid cancer metastasis. KEY WORDS: Follicular thyroid carcinoma, positron emission tomography/computed tomography scalp metastasis
INTRODUCTION Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer which is considered more aggressive than papillary carcinoma. Vascular invasion is characteristic for follicular carcinoma and therefore distant metastasis is more common. FTC can metastasize to lungs, bones, and brain via hematogenous spread.[1] Scalp is an uncommon site for metastasis and which is extremely rare.[2] Metastatic tumors to the scalp are most often from lung, breast, and prostate malignancies and rarely from thyroid cancers.[3] In this case, a 49‑year‑old patient with solitary scalp metastasis from follicular thyroid cancer was presented. The aim if this study was to discuss the imaging and therapy choice of scalp metastases of FTC and alsoto remind that follicular thyroid cancer can metastasize to the scalp. CASE REPORT A 49‑year‑old female patient admitted to hospital with bulging on the left vertex of the scalp. Patient had a subtotal thyroidectomy history 4‑year ago and diagnosed with minimally invasive follicular thyroid cancer which was 0.9 cm in diameter. Radioactive iodine therapy was not given because of tumor size after the operation. Patient did not
come to the hospital for follow‑up examinations and blood test after this period. She was admitted to neurosurgery polyclinic because of bulging on the left side of vertex. She was referred to positron emission tomography (PET)/computed tomography (CT) examination for the evaluation of flourodeoxiglucose (FDG) uptake of this lesion to determine the biopsy side and also to search for the other possible metastases. PET/CT whole‑body imaging was performed after intravenous injection of 420 MBq (11.35 mCi) Flouro‑18 FDG. After 1 h of waiting period in a silent room, the patient was imaged using an integrated PET/CT camera, which was consisted of a six‑slice CT gantry, integrated with a lutetium oxyorthosilicate (LSO) based full‑ring PET scanner (Siemens Bio‑graph 6, IL, Chicago, USA). PET/CT images showed intense FDG uptake on the left vertex of the scalp with a soft‑tissue component on CT slices with a maximum standard uptake value of (SUVmax) 9.8 [Figure 1]. Pathological FDG uptake was not seen on the thyroid bed, cervical regions, and on the skeletal system. After the PET/ CT imaging, excisional biopsy was performed. Histopathological examination revealed a FTC metastasis [Figure 2]. After the operation, patient was referred to the nuclear medicine department for radioactive iodine therapy. High‑dose I‑131 was
Journal of Cancer Research and Therapeutics - April-June 2014 - Volume 10 - Issue 2
Sait Sager, Sabire Yilmaz, Rana Kaya Doner, Mutlu Niyazoglu1, Metin Halac, Bedii Kanmaz Departments of Nuclear Medicine, and 1Endocrinology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey For correspondence: Dr. Sait Sager, Department of Nuclear Medicine, Istanbul University, Cerrahpasa Medical Faculty, Cerrahpasa, Fatih, Istanbul, Turkey. E‑mail: saitsager@ yahoo.com
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.136681 PMID: *** Quick Response Code:
431
Sager, et al.: Solitary scalp metastasis of follicular thyroid carcinoma
Figure 1: Selected coronal, axial and sagittal positron emission tomography/ computed tomography and fusion images showed incresed flourodeoxiglucose uptake on the left vertex of scalp with SUVmax of 9.8
given and whole body I‑131 imaging was performed 3 days after the therapy which showed focal uptake on thyroid bed [Figure 3]. Six months after the radioactive iodine therapy, low dose I‑131 whole‑body image was evaluated as normal and the patient’s thyroglobulin levels were
