Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
A 45-year-old woman presented with a headache and visual complaints. Brain MRI revealed a large mass in the right occipital cortex. The tumor was surgically removed and pathological examination showed papillary carcinoma originating from thyroid gland. She had a history of thyroid surgery 27 years ago indicating papillary thyroid cancer with central neck lymph node involvement followed by no additional treatments. CT scan showed a mass in the right kidney and multiple liver cysts. She was referred and treated with curative dose of radioiodine. A post therapeutic iodine scan showed accumulation of the tracer in the right kidney and disseminated uptake in the lungs and neck, with no focal uptake in the liver. To increase iodine accumulation in the lungs with curative intention, the right kidney was surgically resected. Forty-five days after nephrectomy, the patient received her second dose of radioiodine. In the second post therapy scan, the uptake in the lungs and neck was significantly enhanced. The ratio of lungs to whole body uptake was 17.2% and 46.2% in the first and second post therapeutic scan, respectively. Not only unilateral kidney metastasis from PTC is rare incidentally noticed non-metastatic multiple liver cysts in this patient are interesting to report, also the benefit from metastasectomy of asymptomatic visceral metastasis is documented. Such a visceral metastasectomy could result in optimal radiation to other sites, being lung metastases in this case.
Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S; American Thyroid Association Guidelines Task Force. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015 Jul;25(7):716-59.
Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG. Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg. 2003 Jul;197(1):29-37.
Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol. 2002 Mar;178(3):699-704.
Busaidy NL, Cabanillas ME. Differentiated thyroid cancer: management of patients with radioiodine nonresponsive disease. J Thyroid Res. 2012;2012:618985.
Song HJ, Xue YL, Xu YH, Qiu ZL, Luo QY. Rare metastases of differentiated thyroid carcinoma: pictorial review. Endocr Relat Cancer. 2011 Aug 30;18(5):R165-74.
Song JS, Taylor SM, Trites J, Rigby MH, Bullock MJ, Merrimen J, Rendon R, Hart RD. Tumor-to-tumor metastases: papillary thyroid carcinoma into a clear cell renal cell carcinoma. J Otolaryngol Head Neck Surg. 2017 Mar 1;46(1):17.
Gamboa-Dominguez A, Tenorio-Villalvazo A. Metastatic Follicular Variant of Papillary Thyroid Carcinoma Manifested as a Primary Renal Neoplasm. Endocr Pathol. 1999 Autumn;10(3):256-268.
Nath V, Baliga M, Lewin J, Souza F, Akhtar I. Follicular thyroid carcinoma metastatic to the kidney: Report of a case with cytohistologic correlation. Case Rep Pathol. 2015;2015:701413.
Lubana SS, Singh N, Tuli SS, Bashir T, Sachmechi I, Kemeny MM. Follicular variant of papillary thyroid cancer with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer: A rare occurrence. Am J Case Rep. 2015 Jul 16;16:459-68.
Chen-Ku CH, Roldán B. Unusual papillary thyroid cancer metastases to kidney and pharynx: A case report. AACE Clin Case Rep. 2016;2(2):e86-e90.
Vrachimis A, Schmid KW, Jürgens H, Schober O, Weckesser M, Riemann B. Cerebral metastases from thyroid carcinoma: complete remission following radioiodine treatment. Dtsch Arztebl Int. 2013 Dec 13;110(50):861-6.
Borde C, Basu S, Kand P, Arya S, Shet T. Bilateral renal metastases from papillary thyroid carcinoma on post 131I treatment scan: flip-flop sign, radioiodine SPET, 18F-FDG PET, CECT and histopathological correlation. Hell J Nucl Med. 2011 Jan-Apr;14(1):72-3.
Kwong N, Marqusee E, Gordon MS, Larsen PR, Garber JR, Kim MI, Alexander EK. Long-term, treatment-free survival in select patients with distant metastatic papillary thyroid cancer. Endocr Connect. 2014 Dec;3(4):207-14.
Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, Caillou B, Ricard M, Lumbroso JD, De Vathaire F, Schlumberger M. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006 Aug;91(8):2892-9.
Salehi, Y., Naseri, M., Farzanefar, S., & Abbasi, M. (2018). Papillary thyroid cancer with metastases to brain, lung and kidney: A case of dosimetry proven privilege of surgical resection of organ metastases. Iranian Journal of Nuclear Medicine, 26(1), 58-61.
MLA
Yalda Salehi; Maryam Naseri; Saeed Farzanefar; Mehrshad Abbasi. "Papillary thyroid cancer with metastases to brain, lung and kidney: A case of dosimetry proven privilege of surgical resection of organ metastases". Iranian Journal of Nuclear Medicine, 26, 1, 2018, 58-61.
HARVARD
Salehi, Y., Naseri, M., Farzanefar, S., Abbasi, M. (2018). 'Papillary thyroid cancer with metastases to brain, lung and kidney: A case of dosimetry proven privilege of surgical resection of organ metastases', Iranian Journal of Nuclear Medicine, 26(1), pp. 58-61.
VANCOUVER
Salehi, Y., Naseri, M., Farzanefar, S., Abbasi, M. Papillary thyroid cancer with metastases to brain, lung and kidney: A case of dosimetry proven privilege of surgical resection of organ metastases. Iranian Journal of Nuclear Medicine, 2018; 26(1): 58-61.
)