Technetium-99m-sestamibi uptake by recurrent Hurthle cell carcinoma of the thyroid.

Technetium-99m-sestamibi has been reported to localize in various tumors. Scintigraphic results for a patient with recurrent Hurthle cell carcinoma of the thyroid whose tumor was imaged with both 99mTc-sestamibi and 201TI, but not with 131I, are presented.     

Metastatic Hurthle cell carcinoma and medical certification

Thyroid carcinoma is the most common malignancy of the endocrine system. Thyroid cancers generally have a favorable prognosis but require ongoing follow-up. Surgery is the treatment of choice. Thyroglobulin can be a useful tumor marker for disease surveillance. Disease impact on safety of flight is the primary aeromedical concern.     

A case of Hurthle cell carcinoma in the superior mediastinum

This is a report for an unusual case of oxyphilic cell adenocarcinoma originating from anterior mediastinum in a 36-year-old male who complained of his neck lymphoadenopathy. 201Tl whole body scanning showed increased uptake of the left supraclavicular and upper mediastinal regions. There was no history of prior operation nor irradiation to the thyroid or neck region. Chest CT scanning also demonstrated the tumor in the superior mediastinum, but the mass has no increased 67Ga uptake. No tumor in the thyroid lobes was apparent on thyroid scintiscanning, ultrasonography and neck CT. The mediastinal tumor resection, the right and left thyroid lobectomy and the neck lymphonodectomy were completed. Serial sectioning of the resected thyroid lobes failed to show any tumorous tissue. The light microscopic features of a Hurthle-cell tumor arising in the mediastinal ectopic thyroid and diagnosed by neck lymph node biopsy were presented. The tumor was clinically malignant, having metastasized to the bone and the neck lymph nodes. Non surgical treatment including radioactive iodine (131I) therapy and combination chemotherapy were disappointing. The patient deteriorated progressively and died 16 months after thyroidectomy. We describe here an unusual case of a papillary growing and thyroglobulin producing tumor in the superior mediastinal region without evidence of a primary thyroid gland tumor.     

Thyrotoxicosis caused by functioning metastatic thyroid carcinoma. A rare and elusive cause of hyperthyroidism with low radioactive iodine uptake

A patient with progressively worsening thyrotoxicosis, refractory to medical therapy, is described. Repeated measurements of thyroidal RAI uptake over a 13 month period were low consistently and could not be explained by iodine ingestion, thyroiditis, or administration of exogenous thyroid hormone. An I-131 scan ultimately revealed striking activity at the base of the skull, reflecting ectopic excessive production of thyroid hormone by a solitary functioning metastatic thyroid carcinoma. The thyrotoxic state resolved after large doses of therapeutic I-131. Typical features of this rare cause of hyperthyroidism are discussed.     

Hemothorax: the unique presenting symptom of a chondroblastoma of the rib

A left pleural effusion accompanying a soft tissue mass and a lytic lesion of one rib were the unusual presenting manifestation of a bleeding chondroblastoma in a young adult patient.     

Squamous cell carcinoma of the thyroid

A patient with squamous cell carcinoma of the thyroid is presented. The I-123 images failed to show any cold areas but demonstrated the posterior extension of the gland.     

Thyroid carcinoma presenting as an autonomous thyroid nodule

A case of follicular thyroid cancer appearing as an autonomous nodule on Tc-99m and I-123 thyroid scintigraphy is presented in addition to a pertinent review of the literature.     

Metastatic deposits from a previously treated carcinoma of the lung presenting as a renal cell carcinoma

Two patients are presented who had each previously undergone resection of a primary lung carcinoma. They later developed the classical triad of loin pain, haematuria and an abdominal mass suggestive of a primary renal tumour. Investigations, including intravenous urography, ultrasound and renal arteriography, supported the diagnosis. However, at operation both patients had para-aortic lymph node metastases from the lung carcinoma surrounding the renal pedicle and invading the renal parenchyma. It is suggested that further investigations might allow pre-operative diagnosis and thus avoid the need for surgery in such patients.     

Case report: metastatic transitional cell carcinoma presenting in a urinoma.

We describe a case of transitional cell carcinoma (TCC) metastasising into a urinoma cavity in a patient where the primary tumour arose at the ipsilateral ureterovesical junction. Seeding of transitional cell carcinoma into contiguous structures following surgical intervention has been reported, but to our knowledge, this is the first report of spread into a distant urinoma.     

以肱骨转移为先发症状的隐匿型甲状腺乳头状癌临床分析一例

以肱骨转移包块为先发症状的甲状腺乳头状癌转移病例在临床中并非罕见,笔者报道的这例病例特殊之处在于行甲状腺全切除及颈部淋巴结清扫手术后,术后病理结果未发现确切的原发病灶,再次行PET/CT检查及131I治疗后的全身碘扫描中发现了左侧髂骨病灶,行髂骨病灶手术切除术后,病理结果证实为另一处甲状腺乳头状癌骨转移灶,再次行131I治疗、规范TSH抑制治疗,诊治过程中不断更新诊断标准,制定出针对性的治疗方案,最终患者得到了有效的治疗。     

The role of technetium-99m sestamibi whole-body scans in diagnosing metastatic Hurthle cell carcinoma of the thyroid gland after total thyroidectomy: a comparison with iodine-131 and thallium-201 whole-body scans

Thirty-seven patients with Hürthle cell carcinoma of the thyroid gland underwent total thyroidectomy and then technetium-99m sestamibi (2-methoxyisobutylisonitrile), iodine-131 and thallium-201 wholebody scans. Twenty-two of them had elevated human serum thyroglobulin (HTg) levels. Among these 22 patients, abnormal uptake of ¹³¹I was seen in four (18.1%), abnormal uptake of ²⁰¹Tl chloride in 15 (68.1%), and abnormal ^99mTc-sestamibi accumulation in 18 (81.8%). No patients with normal levels had a positive whole-body scan. In comparison with the 1311 and 201T1 chloride images, the ^99mTc-sestamibi images were of superior quality and detected significantly more (P < 0.05) metastatic lesions of Hurthle cell carcinoma of the thyroid gland in patients with elevated HTg after total thyroidectomy. A mechanism is proposed that may explain these findings.