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Year : 2015  |  Volume : 30  |  Issue : 4  |  Page : 358-359  

Unusual case of hepatic metastasis in follicular thyroid carcinoma detected using I-131 whole body scintigraphy and single-photon emission computerized tomography/computerized tomography


1 Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
2 Department of Medical Oncology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India

Date of Web Publication1-Sep-2015

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


DOI: 10.4103/0972-3919.164017

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   Abstract 

Papillary and follicular thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Distant metastases are rare events at the onset of DTC. Among these presentations, metastasis to the liver is even more unusual. Only 11 cases of DTC with liver metastasis were previously reported in the literature. We present a 55-year-old male on Iodine-131 whole body scintigraphy showed intense uptake in thyroid bed, metastasis in both lungs and right lobe of the liver. Radioiodine concentration in liver metastases made him amenable to high-dose radioiodine therapy patient.

Keywords: Follicular carcinoma, I-131 single-photon emission computerized tomography/computerized tomography, liver metastasis, radioiodine treatment


How to cite this article:
Kamaleshwaran KK, Natarajan S, Mohanan V, Shinto AS. Unusual case of hepatic metastasis in follicular thyroid carcinoma detected using I-131 whole body scintigraphy and single-photon emission computerized tomography/computerized tomography. Indian J Nucl Med 2015;30:358-9

How to cite this URL:
Kamaleshwaran KK, Natarajan S, Mohanan V, Shinto AS. Unusual case of hepatic metastasis in follicular thyroid carcinoma detected using I-131 whole body scintigraphy and single-photon emission computerized tomography/computerized tomography. Indian J Nucl Med [serial online] 2015 [cited 2020 Jan 22];30:358-9. Available from: http://www.ijnm.in/text.asp?2015/30/4/358/164017

A 55-year-old man underwent total thyroidectomy which revealed follicular thyroid carcinoma (FTC). After 1-month, his thyroid stimulating hormone (TSH) was >100 mIU/L and serum thyroglobulin was 26,500 ng/ml, he was referred for I-131 whole body scintigraphy (WBS) which showed uptake in neck, bilateral lungs and an intense uptake in the right side of abdomen [Figure 1]. Single-photon emission computerized tomography/computerized tomography (SPECT/CT) of abdomen localizes intense uptake in the upper abdomen to the lesion in the right lobe of liver [Figure 2]. He underwent high dose radioiodine therapy with the dose of 250 mCi (9.25 Gbq).
Figure 1: Iodine-131 whole body scintigraphy shows uptake in neck, bilateral lung and in right upper abdomen

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Figure 2: Single-photon emission computerized tomography/computerized tomography of abdomen showing increased uptake in the lesion in right lobe of the liver

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Differentiated thyroid cancer (DTC) is the most common endocrine neoplasm. Distant metastases occur in up to 10% of patients with DTC. Larger primary tumor size, extracapsular extension, older age, certain histological variants, and distant metastases have all been identified as risk factors for poorer prognosis, often with a cumulative effect.[1] DTC metastases to the brain, eye, breast, liver, kidney, muscle, and skin are rare or relatively rare and often overlooked in clinical setting.[2] Metastasis to the liver from DTC is a rare event with a reported frequency of 0.5%. Metastatic liver involvement from DTC is nearly always multiple or diffuse and usually found along with other distant metastases (lung, bone and brain).[3] A review of the literature revealed that only 10 cases have been documented. Three were males and seven females with an average age of about 63 years (range from 32 to 85 years). Histologically, the primary tumor was identified as papillary in four patients,[4],[5] follicular in five,[5],[6],[7],[8],[9] and Hűrthle cell TC in one patients.[3] In two cases, the metastatic histological type was inconsistent with the primary tumor. The primary tumors were FTC and papillary thyroid carcinoma (PTC), while both their metastatic lesions were a follicular variant of PTC.[4],[5] Transformation of histopathologic types may occur in liver metastases from DTC, therefore, a careful retrospective histological study is recommended.

Djenic et al. recently reported a solitary liver metastasis from follicular variant of PTC, which was surgically resected.[10] So our case will be the 12th case reported in literature. Most liver metastases from DTC were asymptomatic and were usually discovered incidentally as in our patient. The I-131 WBS combined with SPECT/CT scan plays an important role in increasing diagnostic accuracy, reducing pitfalls, and modifying therapeutic strategies.[11] Song et al. in their pictorial review highlights the diagnostic aspects of I 131-SPECT/CT for the localization and definition of rare metastases in DTC patient.[12] Our patient received I 131 treatment, because of multiple metastasis in lungs and bone. The survival rate after liver metastases is poor; however, it cannot be attributed to liver metastases alone, because it generally appeared after more metastases at other sites.





 
   References Top

1.
Mazzaferri EL, Young RL. Papillary thyroid carcinoma: A 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 1981;70:511-8.  Back to cited text no. 1
    
2.
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. 2
    
3.
Salvatori M, Perotti G, Rufini V, Maussier ML, Summaria V, Fadda G, et al. Solitary liver metastasis from Hürthle cell thyroid cancer: A case report and review of the literature. J Endocrinol Invest 2004;27:52-6.  Back to cited text no. 3
    
4.
Bakheet SM, Powe J, Hammami MM, Amin TM, Akhtar M, Ahmed M. Isolated porta hepatis metastasis of papillary thyroid cancer. J Nucl Med 1996;37:993-4.  Back to cited text no. 4
    
5.
Tur GE, Asanuma Y, Sato T, Kotanagi H, Sageshima M, Yong-Jie Z, et al. Resection of metastatic thyroid carcinomas to the liver and the kidney: Report of a case. Surg Today 1994;24:844-8.  Back to cited text no. 5
    
6.
Kraft O. Hepatic metastasis of differentiated thyroid carcinoma. Nucl Med Rev Cent East Eur 2005;8:44-6.  Back to cited text no. 6
    
7.
Guglielmi R, Pacella CM, Dottorini ME, Bizzarri GC, Todino V, Crescenzi A, et al. Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: Treatment with 131I and interstitial laser ablation. Thyroid 1999;9:173-7.  Back to cited text no. 7
    
8.
Kondo T, Katoh R, Omata K, Oyama T, Yagawa A, Kawaoi A. Incidentally detected liver metastasis of well-differentiated follicular carcinoma of the thyroid, mimicking ectopic thyroid. Pathol Int 2000;50:509-13.  Back to cited text no. 8
    
9.
Kelessis NG, Prassas EP, Dascalopoulou DV, Mishra J, Mohapatra KC, Meher RK. Unusual metastatic spread of follicular thyroid carcinoma: Report of a case. Surg Today 2005;35:300-3.  Back to cited text no. 9
    
10.
Djenic B, Duick D, Newell JO, Demeure MJ. Solitary liver metastasis from follicular variant papillary thyroid carcinoma: A case report and literature review. Int J Surg Case Rep 2015;6C: 146-9.  Back to cited text no. 10
    
11.
Spanu A, Solinas ME, Chessa F, Sanna D, Nuvoli S, Madeddu G 131I SPECT/CT in the follow-up of differentiated thyroid carcinoma: Incremental value versus planar imaging. J Nucl Med 2009;50:184-90.  Back to cited text no. 11
    
12.
Song HJ, Xue YL, Xu YH, Qiu ZL, Luo QY. Rare metastases of differentiated thyroid carcinoma: Pictorial review. Endocr Relat Cancer 2011;18:R165-74.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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