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CASE REPORT
Year : 2015  |  Volume : 30  |  Issue : 4  |  Page : 345-346  

Bilateral breast uptake of radioiodine in a male patient with gynecomastia: A case report


Department of Nuclear Medicine, Istanbul University, Cerrahpasa Medical Faculty, Cerrahpasa, Istanbul, Turkey

Date of Web Publication1-Sep-2015

Correspondence Address:
Lebriz Uslu
Department of Nuclear Medicine, Istanbul University, Cerrahpasa Medical Faculty, Cerrahpasa, Istanbul
Turkey
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Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.


DOI: 10.4103/0972-3919.164026

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   Abstract 


A 56-year-old male patient with papillary thyroid carcinoma was given radioiodine for the treatment of persistent disease. Post radioiodine whole body scan revealed uptake at the thyroidal region and bilateral uptake at the upper thoracic region. Single photon emission computed tomography/computed tomography (SPECT/CT) confirmed uptake at the left thyroid lobe, and additional symmetrical mammary gland uptake was observed at both breasts. The patient had obesity-related gynecomastia, but he did not have any history of breast cancer, mastitis, hyperprolactinemia, or galactorrhea. Although breast uptake of radioiodine is a common finding in postpartum or lactating women, it is uncommon in male patients. To our knowledge, this is the first case of a male patient with breast uptake of radioiodine documented with SPECT/CT. SPECT/CT is useful in male patients in the differentiation of benign breast uptake with lung metastases or axillary metastases of thyroid cancer.

Keywords: Breast uptake, gynecomastia, radioiodine, single photon emission computed tomography/computed tomography, thyroid cancer


How to cite this article:
Uslu L, Ozbayrak M, Vatankulu B, Sonmezoglu K. Bilateral breast uptake of radioiodine in a male patient with gynecomastia: A case report. Indian J Nucl Med 2015;30:345-6

How to cite this URL:
Uslu L, Ozbayrak M, Vatankulu B, Sonmezoglu K. Bilateral breast uptake of radioiodine in a male patient with gynecomastia: A case report. Indian J Nucl Med [serial online] 2015 [cited 2019 Dec 6];30:345-6. Available from: http://www.ijnm.in/text.asp?2015/30/4/345/164026




   Introduction Top


Following radioiodine therapy, a whole body posttreatment radioiodine scintigraphy is performed to localize the tumor extent and possible metastases in patients with differentiated thyroid carcinoma. False positive uptake of radioiodine could be misinterpreted as metastases. Radioiodine uptake of the breast tissue is a common false positive finding in lactating or postpartum women. It can also be seen in the presence of mastitis, hyperprolactinemia, or breast tumor. However, it is very rare in male patients. Here we report a case of a male patient with gynecomastia, who had bilateral symmetrical breast uptake on whole body radioiodine scintigraphy.


   Case Report Top


A 56-year-old male patient diagnosed for papillary thyroid carcinoma was referred to the nuclear medicine department for radioiodine ablation. He had undergone total thyroidectomy operation 1-year ago, and the postoperative pathological examination revealed multicentric papillary thyroid carcinoma with extra thyroidal invasion and positive surgical margins (stage PT3N0M0). The patient had received 1.85 GBq (50 mCi) radioiodine for remnant ablation 7 months ago. Whole body imaging following radioiodine treatment administration showed focal radioiodine uptake at the thyroidal region without any metastatic foci. Six months later serum thyroglobulin level was <0.2 ng/ml and anti-thyroglobulin level was 10.58 IU/ml under thyroid stimulating hormone (TSH) stimulation (TSH level: 60.82 μIU/ml). Diagnostic radioiodine whole body scan with 5 mCi I-131 revealed uptake of persistent remnant tissue at the thyroidal bed. Therefore, the patient was given an amount of 5.55 GBq (150 mCi) of I-131 for the treatment of persistent disease 7 months after the first therapy. Post-radioiodine whole body scan revealed uptake at the thyroidal region as expected and also atypical focal radioiodine accumulation at both sides of the upper thoracic region as well [Figure 1]a.
Figure 1: (a) Post-radioiodine whole body scan with 150 mCi I-131 revealed uptake at thyroidal region and at both sides of the upper thoracic region (arrows). (b) Single photon emission computed tomography/computed tomography image performed after 150 mCi I-131 whole body scan confirmed focal radioiodine uptake at the left thyroidal lobe (arrows). (c) Single photon emission computed tomography/computed tomography image of the thoracic region revealed radioiodine uptake at both breast parenchyma (arrows)

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Additional single photon emission computed tomography/computed tomography (SPECT/CT) acquisition was performed to confirm the radioiodine uptake at the thyroidal bed and also to localize the abrupt foci of radioiodine accumulation at the bilateral upper chest. Intense remnant uptake at the left thyroid lobe was also observed with SPECT/CT scanning [Figure 1]b. There was no discernible uptake at neither cervical nor supraclavicular lymph nodes. Furthermore, SPECT/CT scanning confirmed that symmetrical radioiodine uptake on the chest belongs to breast parenchyma at both sides [Figure 1]c. The patient did not have any history of breast cancer, mastitis, hyperprolactinemia, or galactorrhea, but he had gynecomastia-related with obesity.


   Discussion Top


Radioiodine uptake in the breast is a common finding in postpartum or lactating women.[1],[2],[3],[4] It has also been reported in women with a history of hyperprolactinemia[5] or breast diseases.[6],[7],[8] The exact mechanism of I-131 accumulation by breast tissue is unclear, however, enhanced NIS expression in the breast tissue in lactating women and in the presence of hyperprolactinemia have been proposed.[4] However idiopathic breast I-131 uptake has also been reported, in a nulliparous woman without endocrine abnormality or breast disease.[9] Breast uptake of radioiodine is an uncommon finding in male patients without hyperprolactinemia or breast pathology.

Sodium/iodide symporter (NIS) is the route of access for iodine to the thyroidal follicular cells for normal thyroid hormone synthesis. In the presence of thyroid cancer, radioiodine is transported into the cancer cells via NIS. Radioiodine ablation is usually inefficient in undifferentiated thyroid cancers, as those cells have lost their ability to express NIS. Although the majority of NIS in the body is localized in the thyroid gland, it is also present in nonthyroidal tissues, such as breast, thymus, salivary gland, gastrointestinal tract, and various tumors.[4] Therefore, a false positive uptake of radioiodine, at least hypothetically, could be seen in those tissues with NIS expression.

It is important to identify correctly the breast radioiodine uptake and differentiate it from other possible metastatic foci. Breast uptake on planar whole body I-131 scan could be misinterpreted as lung or axillary metastases of the thyroid cancer. As the case in this report, SPECT/CT is extremely useful to localize such ambiguous uptake due to its cross-sectional nature with the coexistence of strong morphological data provided by CT part of the examination. We administered a higher dose (150 mCi) of radioiodine to avoid a possible third radioiodine therapy as the first radioiodine dose was unsuccessful, and the postoperative pathology revealed extracapsular invasion and positive surgical margins.

To the best of our knowledge, this is the first case in the literature showing benign breast uptake of radioiodine in a male patient with gynecomastia. The presence of bilateral symmetrical breast uptake was helpful for this particular patient to identify correctly the breast accumulation. However, nuclear medicine physician should be more cautious, particularly in the presence of asymmetrical upper chest uptake in a male patient and conventional planar scintigraphy should be supported by additional SPECT or SPECT/CT scanning in such situations when available.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Brzozowska M, Roach PJ. Timing and potential role of diagnostic I-123 scintigraphy in assessing radioiodine breast uptake before ablation in postpartum women with thyroid cancer: A case series. Clin Nucl Med 2006;31:683-7.  Back to cited text no. 1
    
2.
Hammami MM, Bakheet S. Radioiodine breast uptake in nonbreastfeeding women: Clinical and scintigraphic characteristics. J Nucl Med 1996;37:26-31.  Back to cited text no. 2
    
3.
Sinha A, Bradley KM, Steatham J, Weaver A. Asymmetric breast uptake of radioiodine in a patient with thyroid malignancy: Metastases or not? J R Soc Med 2008;101:319-20.  Back to cited text no. 3
    
4.
Oh JR, Ahn BC. False-positive uptake on radioiodine whole-body scintigraphy: Physiologic and pathologic variants unrelated to thyroid cancer. Am J Nucl Med Mol Imaging 2012;2:362-85.  Back to cited text no. 4
    
5.
Kao PF, Chang HY, Tsai MF, Lin KJ, Tzen KY, Chang CN. Breast uptake of iodine-131 mimicking lung metastases in a thyroid cancer patient with a pituitary tumour. Br J Radiol 2001;74:378-81.  Back to cited text no. 5
    
6.
Allen T, Wiest P, Vela S, Hartshorne M, Crooks LA. I-131 uptake in the breast for thyroid cancer surveillance with biopsy-proven benign tissue. Clin Nucl Med 1998;23:585-7.  Back to cited text no. 6
    
7.
Serafini A, Sfakianakis G, Georgiou M, Morris J. Breast cyst simulating metastases on iodine-131 imaging in thyroid carcinoma. J Nucl Med 1998;39:1910-2.  Back to cited text no. 7
    
8.
Bakheet SM, Powe J, Hammami MM. Radioiodine uptake in the chest. J Nucl Med 1997;38:984-6.  Back to cited text no. 8
    
9.
Moslehi M, Assadi M. Bilateral radioiodine uptake by the non-lactating breast of a single nulliparous woman: A case report and literature review. Arch Med Sci 2012;8:575-7.  Back to cited text no. 9
    


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