18F-FDG PET/CT-Guided Clinical Management of the Rare Aggressive

Manuela Vadrucci; Giovanni Serio; Alberto Baroli

doi:10.3803/EnM.2016.31.2.343

Articles

Page Path: HOME > Endocrinol Metab > Volume 31(2); 2016 > Article

Image of Interest ¹⁸F-FDG PET/CT-Guided Clinical Management of the Rare Aggressive "Columnar-Cell" Variant of Papillary Thyroid Cancer: Manuela Vadrucci^1,2, Giovanni Serio³, Alberto Baroli²; Endocrinology and Metabolism 2016;31(2):343-344.
DOI: https://doi.org/10.3803/EnM.2016.31.2.343
Published online: May 13, 2016

¹Department of Health Sciences, University of Milan, Milan, Italy.

²Department of Oncology, Nuclear Medicine Unit, Busto Arsizio, Italy.

³Department of Pathology, Busto Arsizio Hospital, Busto Arsizio, Italy.

Corresponding author: Manuela Vadrucci. Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 21000 Milan, Italy. Tel: +39-331699219, Fax: +39-331699936, manuela.vadrucci@unimi.it

• Received: February 1, 2016 • Revised: April 7, 2016 • Accepted: April 14, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3,231 Views
39 Download
2 Web of Science
2 Crossref
2 Scopus

prev next

Full Article

Download PDF

Article information
References

A 61-year-old man underwent 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) staging for biopsy-proven thyroid carcinoma with right neck nodal metastases (Fig. 1A). Total thyroidectomy with central and right neck lymph node dissection was performed. Final histological diagnosis was "columnar-cell" (CC) variant of papillary thyroid cancer (PTC) and multiple nodal metastases (Fig. 1E). One month later, adjuvant radioiodine treatment (5,550 MBq) was performed, and the post-therapeutic whole-body scan showed only minimal uptake in the thyroid bed, consistent with remnant thyroid tissue (Fig 1B). At patient discharge, serum thyroglobulin was 137 ng/dL.

Three months later, a newly growing lymphadenopathy in the anterior median neck and hard subcutaneous nodules in the left cervical region were detected by a physical examination and ultrasound. They were confirmed as thyroid cancer metastases by fine-needle aspiration biopsy. For restaging purposes, the patient underwent a second ¹⁸F-FDG-PET/CT examination, which identified a suspicious lymphadenopathy in the right supraclavicular fossa (Fig. 1C, arrow) in addition to the known lesions. Serum thyroglobulin was 65 ng/dL at the time. The patient underwent revision surgery of the central and right neck lymph node compartments, in addition to left cervical nodal dissection and surgical removal of the subcutaneous nodules. Histology confirmed metastases of CC PTC in the left cervical soft-tissues (Fig. 1F) and in seven of the total 22 nodes that were removed. Based on the rapid and extended recurrence and the tumor dedifferentiation evidenced by the PET/CT findings, external-beam radiation therapy was recommended as an adjuvant treatment. A total of 44 Gy was delivered to the neck by intensity-modulated radiation therapy. Six months later, serum thyroglobulin dropped to 0.1 ng/dL and 1 year later, a follow-up ¹⁸F-FDG-PET/CT scan showed no signs of disease recurrence (Fig. 1D). CC is a rare histological subtype of PTC, usually associated with more aggressive behavior and a worse overall outcome than the classical variant [1]. In such instances, strict postoperative monitoring is recommended as the early detection and treatment of recurrence may significantly improve survival [2]. Several studies suggested that ¹⁸F-FDG-PET/CT may be a potentially valuable technique in the staging and surveillance of patients with aggressive subtypes of differentiated thyroid cancer such as the CC variant, although there is no definite consensus regarding its indications in routine clinical practice [3]. This is the first reported case of CC PTC evaluated by ¹⁸F-FDG-PET/CT, which was a useful tool in all phases of management for this patient.

Article information

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

References

1. Evans HL. Columnar-cell carcinoma of the thyroid. A report of two cases of an aggressive variant of thyroid carcinoma. Am J Clin Pathol 1986;85:77–80. Article PubMed PDF
2. Zhu J, Wang X, Zhang X, Li P, Hou H. Clinicopathological features of recurrent papillary thyroid cancer. Diagn Pathol 2015;10:96Article PubMed PMC PDF
3. Salvatori M, Biondi B, Rufini V. Imaging in endocrinology: 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/ computed tomography in differentiated thyroid carcinoma: clinical indications and controversies in diagnosis and follow-up. Eur J Endocrinol 2015;173:R115–R130. Article PubMed

Fig. 1

(A) Preoperative 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) scan showing the primary tumor in the right thyroid lobe and gross metastatic right neck lymph nodes. (B) Post-operative 131 whole body scan showing an iodine-avid focus in the thyroid bed. (C) Restaging ¹⁸F-FDG-PET/CT scan detected disease recurrence in the left subcutaneous nodules and in the lymph nodes of the central neck compartment and right supraclavicular fossa (arrow). (D) ¹⁸F-FDG-PET/CT demonstrating complete disease remission 1 year after salvage neck surgery and external beam radiotherapy. (E) Histological examination of the right thyroid lobe showing tumor cells with elongated nuclei and multiple pseudo-stratifications suggestive of the columnar-cell variant of papillary thyroid cancer (H&E stain, ×200). (F) Subcutaneous metastasis of columnar-cell papillary thyroid cancer (H&E stain, ×200).

Figure & Data

References

Citations

Citations to this article as recorded by

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 1. Preoperative Imaging and Diagnostic Evaluation in Thyroid Cancer 2024
Ji Ye Lee, Kwanhoon Jo, Ho-Cheol Kang, Sun Wook Kim, Young Joo Park, Ji-In Bang, Young Shin Song, Min Kyoung Lee, Eun Kyung Lee, Dong-Jun Lim, Yun Jae Chung, Sang-Woo Lee, Dong Gyu Na
International Journal of Thyroidology.2024; 17(1): 21. CrossRef
A case-based approach to aggressive variants of papillary thyroid carcinoma with literature review
JosephAntoine Flordelis Chatto, AnnetteLaurente Salillas
Thyroid Research and Practice.2019; 16(3): 128. CrossRef

PubReader
Cite

CITE

export Copy Format

Close

XML Download

Figure

¹⁸F-FDG PET/CT-Guided Clinical Management of the Rare Aggressive "Columnar-Cell" Variant of Papillary Thyroid Cancer

Fig. 1 (A) Preoperative 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scan showing the primary tumor in the right thyroid lobe and gross metastatic right neck lymph nodes. (B) Post-operative 131 whole body scan showing an iodine-avid focus in the thyroid bed. (C) Restaging 18F-FDG-PET/CT scan detected disease recurrence in the left subcutaneous nodules and in the lymph nodes of the central neck compartment and right supraclavicular fossa (arrow). (D) 18F-FDG-PET/CT demonstrating complete disease remission 1 year after salvage neck surgery and external beam radiotherapy. (E) Histological examination of the right thyroid lobe showing tumor cells with elongated nuclei and multiple pseudo-stratifications suggestive of the columnar-cell variant of papillary thyroid cancer (H&E stain, ×200). (F) Subcutaneous metastasis of columnar-cell papillary thyroid cancer (H&E stain, ×200).

Fig. 1

¹⁸F-FDG PET/CT-Guided Clinical Management of the Rare Aggressive "Columnar-Cell" Variant of Papillary Thyroid Cancer