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Bilateral diffuse fluorodeoxyglucose uptake in thyroid gland diagnosed by fluorodeoxyglucose-positron emission tomography/computed tomography.

Win AZ, Aparici CM - World J Nucl Med (2014)

Bottom Line: Fine-needle aspiration (FNA) of the thyroid mass revealed estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2+ breast cancer.Bilateral diffuse uptake of FDG in thyroid is the most commonly associated with benign conditions.However, FNA biopsies need to be done to rule out metastatic disease in thyroid lesions with diffuse high FDG uptake, especially for patients with history of cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nuclear Medicine Section, San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA.

ABSTRACT
Our patient is a female who was first diagnosed with breast cancer at the age of 23. A follow-up fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) at age 44 revealed diffuse high FDG uptake in an enlarged thyroid gland. Fine-needle aspiration (FNA) of the thyroid mass revealed estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2+ breast cancer. To the best of our knowledge, this is the first case to report breast cancer metastasis to the thyroid in a diffuse pattern on FDG-PET/CT. Bilateral diffuse uptake of FDG in thyroid is the most commonly associated with benign conditions. However, FNA biopsies need to be done to rule out metastatic disease in thyroid lesions with diffuse high FDG uptake, especially for patients with history of cancer.

No MeSH data available.


Related in: MedlinePlus

Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images of the same patient after treatment, showing treatment response. (a) CT image at the level of the thyroid shows significant decrease in size from the prior exam (b) FDG image at the level of the thyroid showing normal mild diffuse FDG activity (c) Hybrid PET/CT fusion image at the level of the thyroid (d) MIP image showing normal thyroid biodistributon and treatment response
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Figure 2: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images of the same patient after treatment, showing treatment response. (a) CT image at the level of the thyroid shows significant decrease in size from the prior exam (b) FDG image at the level of the thyroid showing normal mild diffuse FDG activity (c) Hybrid PET/CT fusion image at the level of the thyroid (d) MIP image showing normal thyroid biodistributon and treatment response

Mentions: Last year, our patient developed a cough, and noted shortness of breath, while climbing stairs. She went to urgent care, and a chest X-ray showed an enlarged heart. Computed tomography (CT) scan revealed a large pericardial effusion, small bilateral pleural effusions, and pulmonary edema. Cytology of the pericardial effusion was consistent with breast cancer. She was discharged with tamoxifen and shortly afterwards, she began to experience difficulty writing, and occasional episodes of right hand twitching. Magnetic resonance imaging of the brain showed cystic and solid enhancing masses suspicious for metastases. As a next step in management, the patient had FDG-PET/CT exam and it showed intensely hypermetabolic bilateral cervical, mediastinal, and hilar nodes, as well as diffuse heterogeneous involvement of the enlarged thyroid gland, all of which are suspicious for malignancy [Figure 1]. Fine-needle aspiration (FNA) biopsy of the thyroid mass revealed ER/PR−, HER2+ metastatic breast cancer. The patient underwent radiation therapy and the tumor responded well to treatment [Figure 2].


Bilateral diffuse fluorodeoxyglucose uptake in thyroid gland diagnosed by fluorodeoxyglucose-positron emission tomography/computed tomography.

Win AZ, Aparici CM - World J Nucl Med (2014)

Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images of the same patient after treatment, showing treatment response. (a) CT image at the level of the thyroid shows significant decrease in size from the prior exam (b) FDG image at the level of the thyroid showing normal mild diffuse FDG activity (c) Hybrid PET/CT fusion image at the level of the thyroid (d) MIP image showing normal thyroid biodistributon and treatment response
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150158&req=5

Figure 2: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images of the same patient after treatment, showing treatment response. (a) CT image at the level of the thyroid shows significant decrease in size from the prior exam (b) FDG image at the level of the thyroid showing normal mild diffuse FDG activity (c) Hybrid PET/CT fusion image at the level of the thyroid (d) MIP image showing normal thyroid biodistributon and treatment response
Mentions: Last year, our patient developed a cough, and noted shortness of breath, while climbing stairs. She went to urgent care, and a chest X-ray showed an enlarged heart. Computed tomography (CT) scan revealed a large pericardial effusion, small bilateral pleural effusions, and pulmonary edema. Cytology of the pericardial effusion was consistent with breast cancer. She was discharged with tamoxifen and shortly afterwards, she began to experience difficulty writing, and occasional episodes of right hand twitching. Magnetic resonance imaging of the brain showed cystic and solid enhancing masses suspicious for metastases. As a next step in management, the patient had FDG-PET/CT exam and it showed intensely hypermetabolic bilateral cervical, mediastinal, and hilar nodes, as well as diffuse heterogeneous involvement of the enlarged thyroid gland, all of which are suspicious for malignancy [Figure 1]. Fine-needle aspiration (FNA) biopsy of the thyroid mass revealed ER/PR−, HER2+ metastatic breast cancer. The patient underwent radiation therapy and the tumor responded well to treatment [Figure 2].

Bottom Line: Fine-needle aspiration (FNA) of the thyroid mass revealed estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2+ breast cancer.Bilateral diffuse uptake of FDG in thyroid is the most commonly associated with benign conditions.However, FNA biopsies need to be done to rule out metastatic disease in thyroid lesions with diffuse high FDG uptake, especially for patients with history of cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nuclear Medicine Section, San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA.

ABSTRACT
Our patient is a female who was first diagnosed with breast cancer at the age of 23. A follow-up fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) at age 44 revealed diffuse high FDG uptake in an enlarged thyroid gland. Fine-needle aspiration (FNA) of the thyroid mass revealed estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2+ breast cancer. To the best of our knowledge, this is the first case to report breast cancer metastasis to the thyroid in a diffuse pattern on FDG-PET/CT. Bilateral diffuse uptake of FDG in thyroid is the most commonly associated with benign conditions. However, FNA biopsies need to be done to rule out metastatic disease in thyroid lesions with diffuse high FDG uptake, especially for patients with history of cancer.

No MeSH data available.


Related in: MedlinePlus