ABSTRACT
OBJECTIVE: To study the association between radioiodine refractory papillary thyroid carcinoma, sodium/iodide symporter (NIS) expression, and the BRAF V600E mutation. METHODS: A study was conducted on 30 radioiodine refractory papillary thyroid carcinoma patients and 30 radioiodine-avid papillary thyroid carcinoma patients. The expressions of sodium/iodide symporter and BRAF V600E mutated protein were determined by immunohistochemistry using formalin-fixed, paraffin-embedded tissue. RESULTS: The mutated BRAF V600E protein was identified in 26 radioiodine refractory papillary thyroid carcinoma subjects (86.7%) and 22 radioiodine-avid papillary thyroid carcinoma subjects (73.3%), with no significant difference between the 2 groups (P = 0.3). Sodium/iodide symporter expression was detected in 4 of 30 cases (13.3%) from the radioiodine-avid papillary thyroid carcinoma group but was negative for all radioiodine refractory cases. There was no association between sodium/iodide symporter expression and radioiodine refractory papillary thyroid carcinoma (P = 0.11). Cases with positive NIS expression were likely negative for BRAF V600E mutation (3/4; P = 0.02). CONCLUSION: Papillary thyroid carcinomas with BRAF V600E mutation were more likely to be negative for NIS expression. BRAF V600E mutation and NIS expressions cannot be used to predict radioiodine sensitivity.
ABSTRACT
Adrenal cortical carcinoma (ACC) is a rare aggressive endocrine tumor with poor prognosis. About 60% of ACC are functional tumors. Bilateral ACC is extremely rare, roughly 2%-10% of cases. Diagnosis and staging of ACC by imaging modalities are crucial for preoperative planning and prognostication. Detection of hyperfunctional bilateral adrenocortical carcinoma by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F- FDG PET/CT) has never been reported. Herein, we report a male patient who presented with Cushing's syndrome, type II diabetes mellitus due to Cushing's syndrome, and hypogonadism with biopsy confirmed left ACC. He underwent 18F-FDG PET/CT to evaluate the contralateral adrenal mass and to plan for laparoscopic adrenalectomy, which subsequently confirmed bilateral ACC. Furthermore, 18F-FDG PET/CT was useful in staging, which revealed paraaortic lymph node and lung metastasis.
ABSTRACT
Renal metastasis of thyroid cancer is extremely rare. We report the case of a 62-year-old woman with Hürthle cell thyroid cancer (HCTC) with lungs, bones, and bilateral kidneys metastases. The renal metastatic lesions were clearly demonstrated by 131I whole body scan (WBS) with SPECT/CT. However, they exhibited false-negative results in 18F-FDG PET/CT, kidney ultrasonography, and contrast-enhanced CT scan. The findings imply that tumors have low glucose metabolism and are able to accumulate radioiodine, which is not commonly found in the relatively aggressive nature of HCTC. The patient received two sessions of 200 mCi 131I therapy within 6 months duration. There was complete treatment response as evaluated by the second post-therapeutic 131I SPECT/CT and serum thyroglobulin. To our knowledge, renal metastasis from HCTC with positive 131I but negative 18F-FDG uptake has not been reported in the literature. This case suggests that 131I SPECT/CT is useful for lesion localization and prediction of 131I therapy response.
ABSTRACT
Objective: Differentiated thyroid cancer (DTC) has a favorable prognosis following treatment by thyroidectomy and subsequent post-operative radioactive iodine therapy (RAIT). However, prognostic factors for the success of the first RAIT remain inconclusive. The aim of the present study was to evaluate prognostic factors for the success of the first RAIT in DTC patients. Material and Method: We retrospectively studied 401 DTC patients who underwent total, near-total and subtotal thyroidectomy followed by high dose RAIT from 1994 to 2004. Successful RAIT was assessed using the following criteria: (a) stimulated serum thyroglobulin (sTg) < 10 ng/ml; (b) negative diagnostic 131I total body scan (DxTBS); and (c) no serial increase in thyroglobulin antibody (TgAb) levels. Factors influencing successful first RAIT were evaluated. Results: In total, 401 patients were enrolled into the present study. Most patients were female (81.5%) and had papillary cell type cancer (74.3%). Median tumor size was 2.55 cm. (range, 011 cm). Metastases at cervical node and distant sites were found prior to RAIT in 167 and 26 patients, respectively. The first RAIT doses of 2.963.7, 5.5 and 7.4 GBq were administered to 133, 262 and 6 patients, respectively. Overall success rate of the first RAIT was 32.9%. From univariate analysis, female sex, age of <45 years, underwent thyroidectomy without cervical lymph node dissection, no multifocality, free surgical margin, no metastasis and sTg of <20 ng/dl at ablation were prognostic factors. Age of <45 years and sTg of <20 ng/dl at ablation were independent significant prognostic factors (both p<0.001) from multivariate analysis. Conclusion: Age below 45 years and sTg below 20 ng/dl at ablation are independent prognostic factors for the success of the first RAIT.
Subject(s)
Iodine Radioisotopes , Thyroid Cancer, Papillary , Thyroid Neoplasms , Female , Humans , Iodine Radioisotopes/therapeutic use , Male , Retrospective Studies , Thyroglobulin , Thyroid Cancer, Papillary/radiotherapy , Thyroid Neoplasms/radiotherapy , ThyroidectomyABSTRACT
Malignant peritoneal mesothelioma (MPM) is a rare but fatal tumor. The clinical presentations and imaging findings are nonspecific and resemble various diseases, including peritoneal metastasis. Imaging findings of MPH on (18)F-(18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) are diverse and not well described. We report the two cases of biopsy-proven MPH using (18)F-FDG PET/CT. In our cases, interesting disease patterns-including MPH arising from visceral peritoneal lining of kidney that suffer from polycystic disease and from the parietal peritoneum beneath the appendectomy scar-were presented. One case showed classical metastases localized within the abdominal cavity; while the other case exhibited the rare pattern of extensive multi-organ metastases. By knowing the possible variations and diagnostic pitfalls of (18)F-FDG PET/CT findings in MPM, more accurate interpretation of such mysterious cancer is attainable.
ABSTRACT
The authors reported an uncommon presentation of metastatic neuroendocrine carcinoma to the breast detected by Tc-99m-HYNIC-TOC SPECT/CT in a 49 years old woman who, previously, had carcinoid tumor of left main bronchus and invasive ductal carcinoma of the right breast. Later, the patient developed left breast mass. Core needle biopsy of the mass revealed poorly differentiated invasive ductal carcinoma. The disease remained stable for 12 years without any treatment on that left breast (due to patient's rejection). On the later investigation using Tc-99m-HYNIC-TOC scintigraphy examination, rather than invasive ductal carcinoma, metastatic neuroendocrine cancer was suggested. The final diagnosis was confirmed by pathological examination after surgical excision. Multiple metastatic lesions of neuroendocrine carcinoma at lung, liver, ovaries, and bones were also depicted. Due to the good behavior of the disease, patient had been doing well for eight months, without specific treatment. This report confirmed the advantage and the accuracy of Tc-99m-HYNIC-TOC scintigraphy in detection of neuroendocrine carcinoma. Furthermore, metastatic neuroendocrine tumor should be in differential diagnosis for patient with breast mass together with history of neuroendocrine tumor
