Endocrine DOI 10.1007/s12020-014-0297-8
ENDOCRINE IMAGING
Metastasis to the thyroid from non-small cell carcinoma of the lung: findings in 18F-FDG PET/CT study Kanhaiyalal Agrawal • James Weaver Hosahalli Krishnamurthy Mohan
•
Received: 8 April 2014 / Accepted: 8 May 2014 Ó Springer Science+Business Media New York 2014
Abstract The incidence of thyroid metastasis from other primary malignancy is rare. In this case, we present the findings of 18F-FDG PET/CT in thyroid metastasis from underlying non-small cell carcinoma of the lung and highlight the importance of tracer uptake pattern recognition within the thyroid on 18F-FDG PET/CT study. Keywords PET/CT
Thyroid metastasis Lung cancer 18F-FDG
Introduction A 65-years-old lady with adenocarcinoma of the right lung (initial stage pT2N2M0; EGFR negative, KRAS point mutation positive) was treated with right pneumonectomy and two cycles of adjuvant cisplatin and vinorelbine chemotherapy. She developed sore throat and right side cervical lymphadenopathy, 3 years after the initial treatment and was referred for 18F-FDG PET/CT study for assessment of possible disease recurrence. 18F-FDG PET/CT
K. Agrawal (&) H. K. Mohan Department of Nuclear Medicine, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, Great Maze Pond, London SE19RT, UK e-mail: [email protected] J. Weaver King’s College London, London, UK H. K. Mohan Clinical PET Centre, King’s College London, London, UK
(Fig. 1a, b, c, d) study demonstrated intense heterogeneous uptake of tracer within both lobes of the thyroid (SUVmax 10.7). There were areas of uptake also seen within the liver, cervical and mediastinal lymph nodes. Ultrasound of the neck was performed (Fig. 1e-left thyroid lobe, Fig. 1f-right thyroid lobe) to characterise the uptake further. This revealed replacement of thyroid tissue in both lobes with abnormal hypoechoic masses having ill defined margins, increased vascularity and punctate calcifications which were highly suspicious for malignant involvement. Fine needle aspiration cytology from the thyroid revealed adenocarcinoma cells positive for TTF-1 staining and negative for thyroglobulin consistent with metastatic pulmonary non-small cell carcinoma. She was provided palliative care, but unfortunately died approximately 6 months after disease recurrence. Although the thyroid is a highly vascular gland, metastases to the thyroid from other primary malignancies are rare and represent less than 4 % of all thyroid malignancies in clinical studies [1]. The breast, lung and kidney cancers are the primary malignancies which have been described to metastasize to the thyroid [1]. These patients usually present with a thyroid nodule or a goiter [1] and in rare instances a rapidly growing tumour resulting in hoarseness, dysphagia or respiratory problems [2]. Ultrasonography of the thyroid usually demonstrates focal or diffusely-infiltrating hypoechoic lesions within the thyroid [3]. In this case, we present the findings of 18F-FDG PET/CT in thyroid metastasis from underlying non-small cell carcinoma of the lung. This case highlights the importance of recognizing tracer uptake pattern within the thyroid in patients undergoing PET/CT imaging. Heterogeneous uptake of 18F-FDG within the thyroid should be further evaluated to exclude underlying malignancy.
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Fig. 1 18F-FDG PET/CT (a–d) study showed intense abnormal diffuse but heterogeneous uptake of tracer in both lobes of the thyroid with maximum standardised uptake value of 10.7 (red arrow in a— Maximum intensity projection, b—axial CT, c—axial PET, d—axial fused PET/CT), in addition to liver (a, black arrow), cervical and mediastinal lymph nodes (a, blue arrow) uptake. Ultrasound of the neck (e, left thyroid, f, right thyroid) revealed replacement of both
Conflict of interest
Nothing to disclose.
References 1. T. Namad, J. Wang, R. Shipley, N. Abdel Karim, Thyroid metastasis from non-small cell lung cancer. Case Rep. Oncol. Med. 2013, 208213 (2013)
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thyroid lobes with hypoechoic masses having ill defined margins, abnormal vascularity and punctuate calcification which were highly suspicious of malignant involvement. Fine needle aspiration cytology from the thyroid showed adenocarcinoma cells positive for TTF-1 and negative for thyroglobulin consistent with metastatic pulmonary nonsmall cell carcinoma
2. S. Cichon´, R. Anielski, A. Konturek, M. Barczyn´ski, W. Cichon´, Metastases to the thyroid gland: seventeen cases operated on in a single clinical center. Langenbecks Arch. Surg. 391, 581–587 (2006) 3. F. Ferrozz, F. Campodonico, F. De Chiara, M. Uccelli, A. Saccani, Thyroid metastases: the echographic and computed tomographic aspects. Radiol. Med. 94, 214–219 (1997)
ENDOCRINE IMAGING
Metastasis to the thyroid from non-small cell carcinoma of the lung: findings in 18F-FDG PET/CT study Kanhaiyalal Agrawal • James Weaver Hosahalli Krishnamurthy Mohan
•
Received: 8 April 2014 / Accepted: 8 May 2014 Ó Springer Science+Business Media New York 2014
Abstract The incidence of thyroid metastasis from other primary malignancy is rare. In this case, we present the findings of 18F-FDG PET/CT in thyroid metastasis from underlying non-small cell carcinoma of the lung and highlight the importance of tracer uptake pattern recognition within the thyroid on 18F-FDG PET/CT study. Keywords PET/CT
Thyroid metastasis Lung cancer 18F-FDG
Introduction A 65-years-old lady with adenocarcinoma of the right lung (initial stage pT2N2M0; EGFR negative, KRAS point mutation positive) was treated with right pneumonectomy and two cycles of adjuvant cisplatin and vinorelbine chemotherapy. She developed sore throat and right side cervical lymphadenopathy, 3 years after the initial treatment and was referred for 18F-FDG PET/CT study for assessment of possible disease recurrence. 18F-FDG PET/CT
K. Agrawal (&) H. K. Mohan Department of Nuclear Medicine, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, Great Maze Pond, London SE19RT, UK e-mail: [email protected] J. Weaver King’s College London, London, UK H. K. Mohan Clinical PET Centre, King’s College London, London, UK
(Fig. 1a, b, c, d) study demonstrated intense heterogeneous uptake of tracer within both lobes of the thyroid (SUVmax 10.7). There were areas of uptake also seen within the liver, cervical and mediastinal lymph nodes. Ultrasound of the neck was performed (Fig. 1e-left thyroid lobe, Fig. 1f-right thyroid lobe) to characterise the uptake further. This revealed replacement of thyroid tissue in both lobes with abnormal hypoechoic masses having ill defined margins, increased vascularity and punctate calcifications which were highly suspicious for malignant involvement. Fine needle aspiration cytology from the thyroid revealed adenocarcinoma cells positive for TTF-1 staining and negative for thyroglobulin consistent with metastatic pulmonary non-small cell carcinoma. She was provided palliative care, but unfortunately died approximately 6 months after disease recurrence. Although the thyroid is a highly vascular gland, metastases to the thyroid from other primary malignancies are rare and represent less than 4 % of all thyroid malignancies in clinical studies [1]. The breast, lung and kidney cancers are the primary malignancies which have been described to metastasize to the thyroid [1]. These patients usually present with a thyroid nodule or a goiter [1] and in rare instances a rapidly growing tumour resulting in hoarseness, dysphagia or respiratory problems [2]. Ultrasonography of the thyroid usually demonstrates focal or diffusely-infiltrating hypoechoic lesions within the thyroid [3]. In this case, we present the findings of 18F-FDG PET/CT in thyroid metastasis from underlying non-small cell carcinoma of the lung. This case highlights the importance of recognizing tracer uptake pattern within the thyroid in patients undergoing PET/CT imaging. Heterogeneous uptake of 18F-FDG within the thyroid should be further evaluated to exclude underlying malignancy.
123
Endocrine
Fig. 1 18F-FDG PET/CT (a–d) study showed intense abnormal diffuse but heterogeneous uptake of tracer in both lobes of the thyroid with maximum standardised uptake value of 10.7 (red arrow in a— Maximum intensity projection, b—axial CT, c—axial PET, d—axial fused PET/CT), in addition to liver (a, black arrow), cervical and mediastinal lymph nodes (a, blue arrow) uptake. Ultrasound of the neck (e, left thyroid, f, right thyroid) revealed replacement of both
Conflict of interest
Nothing to disclose.
References 1. T. Namad, J. Wang, R. Shipley, N. Abdel Karim, Thyroid metastasis from non-small cell lung cancer. Case Rep. Oncol. Med. 2013, 208213 (2013)
123
thyroid lobes with hypoechoic masses having ill defined margins, abnormal vascularity and punctuate calcification which were highly suspicious of malignant involvement. Fine needle aspiration cytology from the thyroid showed adenocarcinoma cells positive for TTF-1 and negative for thyroglobulin consistent with metastatic pulmonary nonsmall cell carcinoma
2. S. Cichon´, R. Anielski, A. Konturek, M. Barczyn´ski, W. Cichon´, Metastases to the thyroid gland: seventeen cases operated on in a single clinical center. Langenbecks Arch. Surg. 391, 581–587 (2006) 3. F. Ferrozz, F. Campodonico, F. De Chiara, M. Uccelli, A. Saccani, Thyroid metastases: the echographic and computed tomographic aspects. Radiol. Med. 94, 214–219 (1997)
