ABSTRACT
BACKGROUND: The brain metastasis from differentiated thyroid carcinoma (DTC) is a rare condition and its prognosis is poor. The standard protocol for screening and treatment of patients with brain metastases from papillary thyroid cancer (PTC) remains controversial. This report aims to share the experience of a single center in the management of brain metastases from DTC. MATERIAL AND METHODS: Five patients with brain metastases were identified from 5000 patients with DTC attending the department of nuclear medicine, Hospital 108 between 2016 to 2022. The statistical software Statistical Package for Social Sciences (SPSS) 20.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. RESULTS: Five patients with brain metastases from DTC were revealed by MRI, 18F-FDG PET/CT with contrast enhancement, and 131I-SPECT/CT. The median time of overall survival (OS) was 15 months, ranging from 10 to 65 months. Two out of the five patients underwent surgery, and futher 2 patients were treated with stereotactic surgery (SRS). All patients are still alive. CONCLUSIONS: Brain metastases from DTC are rare. MRI is the preferred imaging mobility to screen brain lesions in DTC. The primary treatment modalities are surgery and SRS.
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INTRODUCTION AND IMPORTANCE: An adenomatoid odontogenic tumor is a rare medical condition. Large tumor (or several) often appears in the maxillae. In a minority of cases, the tumor(s) appear in the mandible. CASE PRESENTATION: We report on a case of a 24-year-old female diagnosed with a mandibular adenomatoid odontogenic tumor, a giant tumor measuring approximately 22 × 25 × 17 cm. The tumor was located on the side of the mandible, causing facial deformity, malnutrition, and hemorrhaging. We assessed the patient's overall condition, carried out a resection of the tumor and mandible from the right condyle to the left mandibular angle, and reconstructed the mandibular defect with a fibula free flap. After the treatment, the patient was followed up for 1 year, with no recurrence detected over this period. CLINICAL DISCUSSION: Because adenomatoid odontogenic tumors are benign odontogenic lesions, which are painless and slow-growing, most are surgically removed or treated conservatively. However, the above treatment measures cannot be applied in the case of a giant tumor that causes facial deformity, destroys the entire jawbone, and has complications such as hemorrhaging and malnutrition. After the tumor resection, the defect is still significant. Accordingly, reconstruction using a microsurgical bone flap is an effective method instead. CONCLUSION: Large adenomatoid odontogenic tumors in the mandible are rare, and treatment cannot follow conventional methods. Accordingly, defect reconstruction after tumor resection is essential.
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BACKGROUND: In this study, we investigated the relationship between clinicopathologic factors, BRAFV600E mutation status and [18F] F-fluoro-2-deoxyglucose (FDG) avidity in patients with radioiodine (RAI)-negative recurrent or metastatic differentiated thyroid cancer (DTC). METHODS: From 2015 to 2018 all patients with suspected recurrent or metastatic radioiodine-negative DTC patients who underwent FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. Suspected lesions on FDG PET/CT were biopsied and underwent BRAFV600E mutation testing by immunohistochemistry and real-time PCR. Tumor size, recurrent versus metastatic disease, histopathologic features including classical type versus aggressive subtypes (poorly differentiated, tall cell, columnar cell, hobnail variants) and BRAFV600E mutation status were correlated with the SUVmax of highest hypermetabolic lesions on FDG PET/CT by the univariate analysis using logistic regression. RESULTS: Sixty-three consecutive patients, 55 (87.3%) female, with median age of 48 (range 17-81) were included. The majority of patients had BRAFV600E mutation and classical subtype, 55/63 (87.3%) and 45/63(71.4%), respectively. Thyroglobulin at the time of suspected recurrence was 262.7 ng/ml (range 16.3-1000) and patients received a median 3 prior RAI treatments. Fifty-four patients (85.7%) had local recurrence. The majority of patients 58/63 (92.1%) had FDG-avid disease on PET/CT. On univariate analysis, tumor size aggressive histopathologic types and distant metastasis are the significant factors for predicting FDG uptake, p = 0.04, p = 0.001 and p = 0.004 respectively. Although FDG uptake of BRAFV600E bearing recurrent/metastatic RAIR DTC lesions was higher than those without the mutation, the difference did not reach statistical significance, SUVmax of 7.11 versus 4.91, respectively, p = 0.2. CONCLUSION: The majority of recurrent or metastatic RAI-negative DTC have BRAFV600E mutation and detectable disease on FDG PET/CT. FDG avidity of the recurrent or metastatic RAI-negative DTC is independently associated with the aggressive histopathologic features.
