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 Table of Contents     
CASE REPORT
Year : 2010  |  Volume : 25  |  Issue : 4  |  Page : 171-172  

Metastatic involvement of the spleen in differentiated carcinoma of thyroid


Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe Building, Mumbai, India

Date of Web Publication23-Mar-2011

Correspondence Address:
Purushottam Kand
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital, Annexe Building, Jerbai Wadia Road, Parel, Mumbai -400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.78256

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   Abstract 

Splenic metastasis in differentiated thyroid carcinoma is rare occurrence. We describe an unusual case of diffuse metastatic splenic involvement with normal hematological indices in differentiated thyroid carcinoma demonstrated by post-therapy whole body radioiodine scan.

Keywords: Differentiated thyroid carcinoma, fine needle aspiration cytology, splenic metastasis, 131-I whole body scan


How to cite this article:
Kand P, Asopa R. Metastatic involvement of the spleen in differentiated carcinoma of thyroid. Indian J Nucl Med 2010;25:171-2

How to cite this URL:
Kand P, Asopa R. Metastatic involvement of the spleen in differentiated carcinoma of thyroid. Indian J Nucl Med [serial online] 2010 [cited 2019 Sep 18];25:171-2. Available from: http://www.ijnm.in/text.asp?2010/25/4/171/78256

Splenic metastasis of Differentiated Thyroid Carcinoma (DTC) is rare. Literature reveals two cases reported by Pauloni et al, [1] and Mayayo et al. [2] Mohan et al, have reported multiple littoral cell angiomas mimicking metastatic thyroid carcinoma to the spleen. [3]

A 50 year old female patient diagnosed follicular variant of papillary carcinoma of thyroid ([Figure 1] H and E section - 400×) with skeletal metastasis demonstrated avid 131-I concentration in the thyroid bed with focal uptake in multiple skeletal metastatic sites and diffuse uptake in the entire spleen on the whole body post therapy scan in anterior and posterior views [Figure 2] after 3.515 GBq of 131-I ablation dose. USG guided Pap stained FNAC smear from spleen confirmed thyroid carcinoma cells arranged in follicular pattern [Figure 3]. The patient had normal hematological indices even with diffuse splenic involvement seen on the 131-I scan.
Figure 1: H and E section (400×) of the primary site in thyroid bed demonstrating follicular variant of papillary carcinoma of thyroid

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Figure 2: Whole body 131 I post therapy scan demonstrating diffuse intense uptake in the entire spleen with multiple skeletal lesions with focal abnormal tracer concentration

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Figure 3: USG guided Pap stained FNAC smear from spleen demonstrating thyroid carcinoma cells arranged in follicular pattern

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A year later, no new metastatic foci were noted in the post therapy whole body scan after administration of 8.437 GBq 131-I for the metastatic disease indicating stable disease inspite of splenic involvement. 131-I whole body post therapy scan provides improved detection of local and distant metastatic deposits as compared to low-dose diagnostic studies. [4],[5]

Metastatic splenic involvement in DTC is diagnosed with whole body 131-I scan and UGS guided FNAC. Although this marks aggressive spread of the disease, its impact on patient morbidity and mortality remains unexplored due to its rare occurrence.

 
   References Top

1.Paolini R, Toffoli S, Poletti A, Casara D, Moschino P, Fabris F, et al. Splenomegaly as the first manifestation of thyroid cancer metastases. Tumori 1997;83:779-82.  Back to cited text no. 1
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2.Mayayo E, Blázquez S, Gómez-Aracil V, Saurí A, Martinez S. Spleen metastasis from thyroid carcinoma. Report of a case with diagnosis by fine needle aspiration cytology. Acta Cytol 2003;47:1116-8.  Back to cited text no. 2
    
3.Mohan V, Jones RC, Drake AJ 3 rd , Daly PL, Shakir KM. Littoral cell angioma presenting as metastatic thyroid carcinoma to the spleen. Thyroid 2005;15:170-5.  Back to cited text no. 3
    
4.Nemec J, Robling S, Zamrazil V, Pohunkova D. Comparison of the distribution of diagnostic and thyroablative 1-131 in the evaluation of differentiated thyroid cancers. J Nucl Med 1979;20:92-7.  Back to cited text no. 4
    
5.Spies WG, Wojtowicz CH, Spies SM, Shah AY, Zimmer AM. Value of post-therapy whole-body 1-131 imaging in the evaluation of patients with thyroid carcinoma having undergone high dose 1-131 therapy. Clin Nucl Med l989;14:793-800.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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