Abstract
IntroductionWhen a pulmonary nodular lesion is detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in a patient with post-surgical papillary thyroid carcinoma with undetectable serum-stimulated thyroglobulin levels and negative 131I whole body scan, diagnosis and management of the nodule may be confusing.Case presentationWe describe two post-surgical patients with papillary thyroid carcinoma who showed pulmonary nodular lesions detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography. In both cases serum-stimulated thyroglobulin levels were undetectable and nodular lesions were not detected by 131I whole body scan. In the first case, a 64-year-old Asian woman showed one focal increased fluorodeoxyglucose uptake lesion in the right lower lobe of one of her lungs. Based on the histologic study, the pulmonary nodular lesion was diagnosed as a solitary pulmonary metastasis from papillary thyroid carcinoma. In the second case, a 59-year-old Asian woman showed a new pulmonary nodule in the right lower lobe. The computed tomography scan of her chest revealed a 9mm nodule in the anterior basal segment and another tiny nodule in the posterior basal segment of the right lower lobe. Six months later, both nodules had increased in size and miliary disseminated nodules were also seen in both lungs. Based on their histology, the pulmonary nodular lesions were considered to be primary lung adenocarcinoma.ConclusionsThe present cases emphasize that physicians should be cautious and make efforts for an accurate diagnosis of pulmonary nodules detected on F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid carcinoma with no evidence of metastasis such as negative 131I whole body scan and undetectable stimulated serum thyroglobulin levels.
Highlights
When a pulmonary nodular lesion is detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in a patient with post-surgical papillary thyroid carcinoma with undetectable serum-stimulated thyroglobulin levels and negative 131I whole body scan, diagnosis and management of the nodule may be confusing.Case presentation: We describe two post-surgical patients with papillary thyroid carcinoma who showed pulmonary nodular lesions detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography
The detection by fluorodeoxyglucose positron emission tomography (FDG-PET) of a pulmonary nodule in patients with papillary thyroid carcinoma (PTC), even those displaying undetectable stimulated Tg and negative 131I whole body scan (WBS), includes a considerable variety of entities, the diagnosis must be made with caution
We describe two patients who presented with pulmonary nodular lesions by FDG-PET-computed tomography (CT) and unexpected results on histologic confirmation with no evidence for distant metastasis on serum-stimulated Tg and 131I WBS
Summary
The present cases were considered to offer important information that physicians should be cautious and make efforts for an accurate diagnosis about pulmonary nodules on FDG-PET-CT in patients who have PTC with no evidence of metastasis such as negative 131I WBS and undetectable stimulated serum Tg levels. Authors' contributions CHJ and JOM contributed to patients’ diagnosis and treatment. HJG and BYK participated in the literature review. CHK and SKK participated in interpretation of the case. Consent Written informed consents were obtained from the two patients for publication of these case reports and any accompanying images. Author details 1Department of Internal Medicine, Division of Endocrinology and Metabolism, Soonchunhyang University School of Medicine, Bucheon, Korea. Author details 1Department of Internal Medicine, Division of Endocrinology and Metabolism, Soonchunhyang University School of Medicine, Bucheon, Korea. 2Department of Nuclear medicine, Soonchunhyang University School of Medicine, Bucheon, Korea. 3Department of Pathology, Soonchunhyang University School of Medicine, Bucheon, Korea. 4Department of Radiology, Soonchunhyang University School of Medicine, Bucheon, Korea. 5Division of Endocrinology and Metabolism, Soonchunhyang University School of Medicine, #108 Jung-Dong, Wonmi-Ku, Bucheon, Kyunggi-Do 110-746, Korea
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