Papillary thyroid carcinoma identified on bone scan with SPECT/CT in a patient presenting with multiple bone metastases

This is a case report of a 65-year-old female with lumbar vertebral lesions secondary to an unknown primary malignancy. 99mTc-methylene diphosphonate bone scintigraphy showed multiple bone metastases as well as focal extraosseous uptake in the area above the right supraclavicular area. Further imaging with SPECT/CT localized the calcified extraosseous uptake to the right thyroid bed. These findings narrowed down the primary malignancy to a thyroidal origin, which was eventually proven as such through immunohistologic studies of the lumbar lesions. Different pathophysiologic mechanisms of extraosseous uptake in bone scintigraphy and how SPECT/CT can increase the diagnostic value of a standard nuclear medicine procedure are highlighted in this paper.

Metastatic lymph nodes from papillary cancer detected using 99Tc pertechnetate

This is a case report of a 51-year-old female diagnosed with papillary microcarcinoma of the thyroid gland after undergoing total thyroidectomy. A 99mTc pertechnetate thyroid scan was done before radioiodine ablation therapy. It showed cervical neck lymph nodes taking up the radiotracer. Another scan after ablation therapy showed the same nodes taking up the therapeutic iodine131. The paper discusses using 99mTc pertechnetate to detect thyroid cancer metastases.

Bone metastases in 21 patients with differentiated thyroid carcinoma: The influence of age and response to therapy

Bone metastases in differentiated thyroid carcinoma occur in 3-5%of patients. When present, overall 10-year survival rate drops to 13-21%. Although rarely curative, radioactive iodine therapy for bone metastases has been found to improve survival especially in patients younger than 45 years of age. This study aims to investigate the diagnostic circumstances and influence of age on the outcome of patients with bone metastases from differentiated thyroid carcinoma recently managed in one institution. Between November 2001 and October 2007, 21 patients were managed for bone metastases from differentiated thyroid carcinoma. A review of medical records was performed. Of 21 patients, 7 patients were less than or equal to 45 years of age (35.29 plus minus 8.16 years), and were classified as group 1 (stage II "low risk", WHO classification). The rest, 14 patients, were greater than or equal to 45 years old (63.14 plus minus 7.73 years and formed group 2 (stage IV, "high risk", WHO classification). Complete and partial remission was more frequently noted with group I (5 of 7 or 71.4% of patients) than with group II (6 of 14 or 42.9% of patients). Although remission can be observed in both age groups, patients younger than 45 years old at the diagnosis of bone metastases show a better response to therapy.

Paget's disease of the pelvis

Paget's disease, also known as osteitis deformans, is characterized by rapid bone remodeling and the formation of bone that is structurally abnormal. Men are affected twice as often as women. The disease is uncommon in persons of African and Asian descent. The majority of patients with Paget's disease are usually asymptomatic, although the most frequent symptom is pain. This paper aims to present a rare case of Paget's disease in a local setting and to present the scintigraphic features of Paget's disease in correlation with other diagnostic modalities. This is a case of a 69-year-old female with a history of low back pain and difficulty in walking of one month duration. CT scan showed sclerotic changes in the right pelvic bone probably degenerative or infectious in nature, however, neoplastic process is not totally ruled out. Bone scan showed an osteoblastic lesion in the right hemipelvis. Considerations include Paget's disease and metastasis (in the presence of a primary neoplastic lesion). The alkaline phosphatase was elevated. An open bone biopsy of the right pelvis was done. Histopathologic report showed prominent cement lines with numerous large osteoclasts. This was signed-out as Paget's disease of the bone. Paget's disease is rare in the Philippines. Our case illustrated a common clinical feature of the disease seen in an elderly patient presenting with bone pain, elevated alkaline phosphatase value, and associated with cortical thickening and sclerosis of the right pelvis on radiolograph and osteoblastic lesion on bone scan.