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 Table of Contents     
CASE REPORT
Year : 2014  |  Volume : 29  |  Issue : 2  |  Page : 97-98  

Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging of an isolated subcutaneous loin metastasis from primary papillary carcinoma of the thyroid


Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India

Date of Web Publication9-Apr-2014

Correspondence Address:
Koramadai Karuppusamy Kamaleshwaran
Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Centre and Hospital Limited, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.130293

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   Abstract 

Differentiated thyroid cancer frequently metastasizes but generally spreads to regional cervical lymph nodes and, in advanced cases, to the lungs and/or skeleton. Metastases to the skin/subcutaneous tissue are rare. We report 45-year-old male patient presented with a loin swelling which on biopsy showed a papillary carcinoma and referred for fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) to find out the primary disease. PET/CT showed abnormal FDG uptake within a loin metastasis and right lobe thyroid nodule. Fine-needle aspiration from nodule showed papillary carcinoma. Because thyroid cancer can rarely metastasize to the skin, attention should be given to that region during interpretation of the images. He was advised total thyroidectomy and metastasis excision.

Keywords: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography , papillary carcinoma thyroid, subcutaneous metastasis, unknown primary


How to cite this article:
Kamaleshwaran KK, Shibu D, Edathurthy R, Shinto AS. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging of an isolated subcutaneous loin metastasis from primary papillary carcinoma of the thyroid. Indian J Nucl Med 2014;29:97-8

How to cite this URL:
Kamaleshwaran KK, Shibu D, Edathurthy R, Shinto AS. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging of an isolated subcutaneous loin metastasis from primary papillary carcinoma of the thyroid. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 13];29:97-8. Available from: http://www.ijnm.in/text.asp?2014/29/2/97/130293


   Introduction Top


Skin metastasis from a thyroid carcinoma is rarely a presenting feature of an underlying malignancy. [1] Subcutaneous metastasis from differentiated thyroid carcinoma (DTC) is a rare manifestation of disseminated disease. Some of the authors believe that follicular carcinoma of the thyroid has a higher propensity to metastasize to the skin, followed by papillary carcinoma, then anaplastic carcinoma and finally medullary carcinoma. [2] Others believe that papillary carcinoma is the most common thyroid carcinoma metastasizing to the skin. [3] All agree that the scalp is the most common site of thyroid carcinoma skin metastases. Loin metastasis is rare. There are no previous reports of positron emission tomography/computed tomography (PET/CT) in patients with loin metastasis from an unknown primary and identified as papillary cancer thyroid.


   Case Report Top


This was a case report of a 45-year-old male patient who presented with subcuataneous swelling in the left loin, which on biopsy showed metastatic papillary cancer. He was referred for whole body PET/CT for detection of primary site. PET/CT showed an intense uptake in the subcutaneous soft-tissue lesion in the left loin [Figure 1]. Also uptake noted in right lobe thyroid nodule [Figure 2]. Patient underwent fine needle aspiration of the thyroid nodule which confirmed papillary carcinoma. A diagnosis of primary papillary carcinoma of thyroid with subcutaneous loin metastasis was made and he was advised total thyroidectomy and excision of metastasis.
Figure 1: Whole body fluorodeoxyglucose-positron emission tomography/ computed tomography (PET/CT) maximum intensity projection image (a) axial CT (b) PET (c) fused PET/CT (d) showed a intense uptake in the subcutaneous soft tissue lesion in the left loin

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Figure 2: Axial CT (a) PET (b) fused PET/CT (c) showed a intense uptake in the right lobe thyroid nodule

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   Discussion Top


Cutaneous metastasis from DTC is also a rare manifestation of thyroid cancer. A review on roughly 60 cases of DTC skin metastases, which have been documented in the literatures, stated that PC has a greater preponderance for skin metastases. [2] They can be the initial manifestation of an occult thyroid cancer. [3],[4] Dermal lesions typically present as slowly growing erythematous or purple plaques or nodules, usually on the scalp, face, or neck. Clinically, scalp is the most common site for cutaneous metastases. This may relate to local vascular factors essential for the highly complex nature of metastases. [5] Subcutaneous metastases in the loin are extremely rare. PET/CT is very useful in identifying unknown primary cancer from the metastatic lesions. There are reports of PET/CT in identifying occult papillary cancer in a thyroglossal cyst. [6] However, 18 fluorine-fluorodeoxyglucose-PET/CT has a role in 131I-whole body Scan negative patients with elevated thyroglobulin. Reports related to thyroid cancer rare metastases are limited. [7] There are reports of PET/CT in identifying muscle and scalp metastasis from a papillary thyroid cancer. [8],[9] This is the first case of identifying primary papillary cancer with subcutaneous metastasis in PET/CT. Recognizing and understanding the clinical findings may determine the overall management of the patients.

 
   References Top

1.Strate SM, Lee EL, Childers JH. Occult papillary carcinoma of the thyroid with distant metastases. Cancer 1984;54:1093-100.  Back to cited text no. 1
[PUBMED]    
2.Koller EA, Tourtelot JB, Pak HS, Cobb MW, Moad JC, Flynn EA. Papillary and follicular thyroid carcinoma metastatic to the skin: A case report and review of the literature. Thyroid 1998;8:1045-50.  Back to cited text no. 2
    
3.Dahl PR, Brodland DG, Goellner JR, Hay ID. Thyroid carcinoma metastatic to the skin: A cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol 1997;36:531-7.  Back to cited text no. 3
    
4.Alwaheeb S, Ghazarian D, Boerner SL, Asa SL. Cutaneous manifestations of thyroid cancer: A report of four cases and review of the literature. J Clin Pathol 2004;57:435-8.  Back to cited text no. 4
    
5.Avram AM, Gielczyk R, Su L, Vine AK, Sisson JC. Choroidal and skin metastases from papillary thyroid cancer: Case and a review of the literature. J Clin Endocrinol Metab 2004;89:5303-7.  Back to cited text no. 5
    
6.Serrano Vicente J, Infante Torre JR, Rayo Madrid JI, García Bernardo L, Domínguez Grande ML, Durán Barquero C, et al. Occult papillary thyroid carcinoma in thyroglossal cyst diagnosed by (18) FDG PET/CT scan. Rev Esp Med Nucl Imagen Mol 2012;31:229-30.  Back to cited text no. 6
    
7.Song HJ, Xue YL, Qiu ZL, Luo QY. Uncommon metastases from differentiated thyroid carcinoma. Hell J Nucl Med 2012;15:233-40.  Back to cited text no. 7
    
8.Califano I, Quildrian S, Coduti M, Rojas Bilbao E, Otero J, Califano L. Soft tissue metastases from differentiated thyroid cancer diagnosed by 18 F FDG PET-CT. Arq Bras Endocrinol Metabol 2013;57:317-21.  Back to cited text no. 8
    
9.Niederkohr RD, Dadras SS, Leavitt M, McDougall IR. F-18 FDG PET/CT imaging of a subcutaneous scalp metastasis from primary carcinoma of the thyroid. Clin Nucl Med 2007;32:162-4.  Back to cited text no. 9
    


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