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CASE SERIES
Year : 2021  |  Volume : 36  |  Issue : 1  |  Page : 39-42  

Rare thyroid cartilage metastases detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan


Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission05-Jul-2020
Date of Decision14-Jul-2020
Date of Acceptance20-Jul-2020
Date of Web Publication04-Mar-2021

Correspondence Address:
Dr. Nitin Gupta
Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_143_20

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   Abstract 


Metastatic lesions to thyroid cartilage are very rare and can be often missed on conventional imaging. Anatomical and functional fused positron emission tomography/computed tomography (PET/CT) imaging has higher sensitivity as compared to conventional CT imaging and can thus identify such atypical sites of metastasis. Here, we present four cases of thyroid cartilage metastases detected on 18fluorodeoxyglucose PET/CT scan from carcinoma lung, breast, stomach and urinary bladder.

Keywords: 18fluorodeoxyglucose positron emission tomography/computed tomography scan, breast, lung, stomach, thyroid cartilage, urinary bladder


How to cite this article:
Gupta N, Verma R, Belho ES. Rare thyroid cartilage metastases detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Indian J Nucl Med 2021;36:39-42

How to cite this URL:
Gupta N, Verma R, Belho ES. Rare thyroid cartilage metastases detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Indian J Nucl Med [serial online] 2021 [cited 2021 Apr 22];36:39-42. Available from: https://www.ijnm.in/text.asp?2021/36/1/39/310783




   Introduction Top


The thyroid cartilage metastases are very rare, and their involvement signifies extensive metastatic lesions and poor prognosis. Initially, laryngeal cartilage metastases remain asymptomatic, and in later stages, they can present with neck pain or hoarseness of voice. Laryngeal metastases have been previously reported from renal, breast, or lung tumors. Our 4 cases with primary each from the stomach, urinary bladder, and lung with fluorodeoxyglucose (FDG) avid metastatic lesion involving thyroid cartilage were detected during staging scan and in follow-up scan of carcinoma left breast.


   Case Reports Top


Case 1

A 58-year-old male presented with chest pain and shortness of breath. CT scan was suggestive of the left hilar lesion. In view of suspicion of carcinoma lung, the patient was referred for whole-body FDG positron emission tomography/computed tomography (PET/CT) scan which revealed FDG avid lesion in the left hilar region and multiple FDG avid metastatic lesions along with FDG avid lesion also involving left lamina of thyroid cartilage with associated soft component [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, [Figure 1]g. The biopsy from the left hilar mass confirmed left lung carcinoma.
Figure 1: (a) Maximum intensity projection image of F-18 fluorodeoxyglucose positron emission tomography-computed tomography. Axial computed tomography and fused positron emission tomography/computed tomography (b-c) images showing fluorodeoxyglucose avid lesion in left hilar region. Axial computed tomography and fused positron emission tomography/computed tomography (d-g) images showing fluorodeoxyglucose avid lytic lesion with associated soft tissue component involving left lamina of the thyroid cartilage

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Case 2

A 63-year-old female, known case of metastatic carcinoma left breast, postleft modified radical mastectomy (10 years back), postchemotherapy, and radiotherapy, now presented with jaundice and generalized body pain. MIP image [Figure 2]a revealed multiple FDG avid metastatic lesions. Axial CT and fused PET/CT images [Figure 2]b and [Figure 2]c revealed a left mastectomy status. Axial CT and fused PET/CT images suggestive of FDG avid lesion involving thyroid cartilage [Figure 2]d, [Figure 2]e, [Figure 2]f, [Figure 2]g.
Figure 2: (a) Maximum intensity projection image of F-18 fluorodeoxyglucose positron emission tomography-computed tomography. Axial computed tomography and fused positron emission tomography/computed tomography (b and c) images are showing left mastectomy status. Axial computed tomography and fused positron emission tomography/computed tomography images (d-g) showing fluorodeoxyglucose avid lytic lesion involving the thyroid cartilage

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Case 3

A 42-year-old male, recently diagnosed case of adenocarcinoma stomach, was referred for staging whole-body FDG PET/CT scan. MIP image [Figure 3]a revealed multiple FDG avid metastatic lesions. Axial CT and fused PET/CT image [Figure 3]b and [Figure 3]c revealed FDG avid mural thickening along Antero-pyloric region of the stomach and axial CT and fused PET/CT images suggestive of FDG avid lesion involving thyroid cartilage [Figure 3]d, [Figure 3]e, [Figure 3]f, [Figure 3]g.
Figure 3: (a) Maximum intensity projection image of F-18 fluorodeoxyglucose positron emission tomography-computed tomography. Axial computed tomography and fused positron emission tomography/computed tomography (b-c) images showing fluorodeoxyglucose avid mural thickening involving the antero-pyloric region of the stomach. Axial computed tomography and fused positron emission tomography/computed tomography (d-g) images showing fluorodeoxyglucose avid lytic lesion involving the thyroid cartilage

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Case 4

A 56-year-old male, recently diagnosed case of carcinoma urinary bladder, was referred for staging whole-body FDG PET/CT scan. MIP image [Figure 4]a revealed multiple FDG avid metastatic lesions. Whole-body PET/CT scan reveals FDG avid mural thickening involving the posterior and bilateral walls of the urinary bladder, corresponding to the known primary site and multiple FDG avid metastatic lesions and FDG avid lesion involving the left lamina of thyroid cartilage [Figure 4]b, [Figure 4]c, [Figure 4]d, [Figure 4]e, [Figure 4]f, [Figure 4]g.
Figure 4: (a) Maximum intensity projection image of 18F-fluorodeoxyglucose/computed tomography scan. Sagittal computed tomography and fused positron emission tomography/computed tomography (b and c) images showing fluorodeoxyglucose avid mural thickening involving the urinary bladder, the primary site. Axial computed tomography and fused positron emission tomography/computed tomography (d-g) images showing fluorodeoxyglucose avid lytic lesion involving the left lamina of the thyroid cartilage

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   Discussion Top


Secondary tumors of the thyroid cartilage are extremely rare. Primary malignancies that commonly metastasize to the thyroid cartilage arise from the adjacent tissues, for example, the larynx, the vallecula, and pyriform sinus.[1] Metastatic involvement of the larynx is rare due to the absence of vessels within the cartilaginous tissue. The probability of metastatic spread increases with aging as a result of larynx ossification. Metastasis to laryngeal cartilages is relatively rare and mainly arises from renal cell carcinoma,[2] melanoma,[3] and rarely from the lung.[4] Till now, very few case reports have been published describing metastatic lesions to the thyroid cartilage.[5],[6]

These lesions might be missed on conventional imaging; however, with present PET/CT fusion imaging combining anatomical and functional information, and it becomes easier to detect these subtle lesions. Since these lesions are associated with multiple metastases, thus biopsy of the thyroid cartilage lesion is not usually performed. As seen in our cases, these thyroid cartilage lesions are associated with multiple other metastatic lesions and thus carry a poor prognosis. Early metastases, when confined to the thyroid cartilage, are often asymptomatic. As a result, they are seldom diagnosed early and usually present at a late stage when there is a presence of more advanced disease, thus implicating poor prognosis.

Laryngeal cartilage metastasis starts by micrometastases within the hematopoietic tissue of the ossified laryngeal parts. Then they merge to form visible focal tumor nodules, and further growth causes destruction of the laminas, and subsequently, the tumor extension is seen into perilaryngeal soft tissue. Different PET/CT scan tracers like FDG PET/CT scan, PSMA PET/CT scan,[7] 18Flurcholine PET/CT scans[8] and 18F-Choline and 64Cu-PSMA PET/CT[9] scans have been reported to be useful to detect thyroid cartilage metastases. Thus, a review of the literature and our case series describes that fused imaging PET/CT scans can detect these rare sites of metastases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Timon CI, Gullane PJ, Brown D, Van Nostrand AW. Hyoid bone involvement by squamous cell carcinoma: Clinical and pathological features. Laryngoscope 1992;102:515-20.  Back to cited text no. 1
    
2.
Ferlito A, Pesvento G, Meli S, Recher G, Visona A. Metastasis to the larynx revealing a renal cell carcinoma. J Laryngol Otol 1987;101:843-50.  Back to cited text no. 2
    
3.
Zenga J, Mehrad M, Bradley JP. Metastatic cancer to the larynx: A case report and update. J Voice 2016;30:774.e9–774.e12  Back to cited text no. 3
    
4.
Ogata H, Ebihara S, Mukai K, Mashima K, Saikawa M, Asai M, et al. Laryngeal metastasis from a pulmonary papillary adenocarcinoma: A case report. Jpn J Clin Oncol 1993;23:199-203.  Back to cited text no. 4
    
5.
Tripathy S, Parida GK, Singhal A, Shamim SA, Kumar R. Thyroid cartilage metastases on F-18 Fluorodeoxyglucose positron emission tomography-computed tomography: A tale of two cases with a brief review of literature. Indian J Nucl Med 2019;34:220-2.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Bracanovic D, Vukovic V, Janovic A, Radosavljevic D, Rakocevic Z. Hyoid bone and thyroid cartilage metastases from sigmoid colon adenocarcinoma: A case report. Balkan Med J 2017;34:278-80.  Back to cited text no. 6
    
7.
Tupalli A, Damle NA, Thankarajan AS, Mangu BS, Kumar A, Khan D, et al. An Unusual Case of Simultaneous Cricoid and Thyroid Cartilage Metastases from Prostatic Adenocarcinoma on 68Ga-PSMA PET/CT. Nucl Med Mol Imaging. 2020;54:61-62.  Back to cited text no. 7
    
8.
Ng SJ, Sinha AK, Loi HY, Khor LK. Asymptomatic metastasis to cricoid from prostate carcinoma: An incidental finding detected on 18F-choline PET/CT. Jpn J Radiol 2015;33:298-301.  Back to cited text no. 8
    
9.
Annovazzi A, Faiella A, Pescarmona E, Sanguineti G, Sciuto R. Asymptomatic metastasis to thyroid cartilage detected by 18F-choline and 64Cu-PSMA PET/CT as a single site of disease relapse in a patient with castration-resistant prostate carcinoma. Clin Nucl Med 2020;45:214-6.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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