Endocrinol Metab.  2010 Dec;25(4):365-369. 10.3803/EnM.2010.25.4.365.

A Case of Residual Medullary Thyroid Carcinoma Detected by 18F-FDG-PET/CT in Patient with Persistent Hypercalcitoninemia

• Kim JY
• Byun DW
• Seo KI
• Jin SY
• Yoo MH

• KMID: 1497764
• DOI: http://doi.org/10.3803/EnM.2010.25.4.365

Abstract

Medullary thyroid carcinoma (MTC) is a rare and challenging malignancy. In patients with residual MTC, the tumor detection rate is generally low for most of the currently available imaging techniques. Various imaging methods have already been used for the detection of residual tumor, but no modality has been shown to be superior to others. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been proposed to identify residual MTC, but this procedure also has limitations as small masses are rarely detected. So, a multimodality imaging approach is recommended for detecting residual MTC. We report here on a case of residual MTC that was detected by 18F-FDG PET/CT in a patient with persistent hypercalcitoninemia after total thyroidectomy and bilateral lymph node dissection.

Keyword

Meduallary carcinoma; Calcitonin; Positron-Emission Tomography

MeSH Terms

Calcitonin
Electrons
Fluorodeoxyglucose F18
Humans
Lymph Node Excision
Neoplasm, Residual
Positron-Emission Tomography
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Calcitonin
Fluorodeoxyglucose F18

Figure

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  Fig. 1 Cut surface of the thyroid gland. An ovoid well encapsulated gray white solid nodule, measuring 1.8 cm in diameter, is seen in the right lobe.

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  Fig. 2 Microscopic findings of the thyroid gland mass. (A) Thick trabeculae or nests of rare atypical polygonal cells are seen without areas of follicular arrangement (H&E, × 40). (B) Tumor cells have eccentric nuclei with finely stippled chromatin and abundant eosinophilic granular cytoplasm (H&E, × 400).

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  Fig. 3 18F-FDG PET/CT. The 18F-FDG PET/CT shows increased uptake in right cervical lymph node.

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  Fig. 4 Fine needle aspiration cytology of neck mass. Loose clusters of or individual tumor cells with eccentric nuclei and marked anisonucleosis are found (H&E, × 200).

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  Fig. 5 Microscopic findings of neck mass. (A) The nodal architecture is mostly destroyed by metastasis of large atypical tumor cells resembling the original thyroid mass (H&E, × 40). (B) Tumor cells are strongly positive for calcitonin (immunohistochemistry for calcitonin, × 200).

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