Renal Metastasis from Follicular Thyroid Carcinoma Diagnosed by I-131 Whole-body Scan Mimicking Renal Cell Carcinoma on
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CASE REPORT
Renal Metastasis from Follicular Thyroid Carcinoma Diagnosed by I-131 Whole-body Scan Mimicking Renal Cell Carcinoma on Contrast-Enhanced Computed Tomography Miju Cheon & Joon Young Choi & Hee Kyung Kim & Jae-Hoon Chung & Young Hyeh Ko & Young Eun Kim & Dongil Choi & Kyung-Han Lee & Byung-Tae Kim
Received: 28 July 2010 / Accepted: 3 November 2010 / Published online: 2 December 2010 # Korean Society of Nuclear Medicine 2010
Abstract Clinically detectable well-differentiated metastatic thyroid carcinoma to the kidney is rare and should be differentiated from primary renal malignancy. We report a case of renal metastases from follicular thyroid carcinoma (FTC) diagnosed by I-131 whole body scan. Additional features of this case different from previous case reports are solitary renal metastasis on I-131 whole body scan and mimicry of renal cell carcinoma on contrast-enhanced computed tomography. Keywords Follicular thyroid carcinoma . Renal metastasis . Renal cell carcinoma . I-131 whole body scan
M. Cheon : J. Y. Choi (*) : K.-H. Lee : B.-T. Kim Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710, Seoul, Korea e-mail: [email protected] H. K. Kim : J.-H. Chung Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea Y. H. Ko : Y. E. Kim Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea D. Choi Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
Introduction Although secondary tumors involving the kidneys are not uncommon, it is rare to find metastatic renal cancer from differentiated thyroid carcinoma (DTC). It is important to differentiate between renal cell carcinoma (RCC) and renal metastases in order to determine indications for surgery. Due to its high specificity, I-131 whole body scans (WBS) are suggested to diagnose renal metastasis from DTC [1–5]. There are 20 case reports about renal metastasis from DTC in the literature. Among them, only five case reports presented renal metastasis from DTC demonstrated by I131 WBS (Table 1) [1–5]. All had multiple functioning metastases on I-131 WBS. Contrast-enhanced computed tomography (CECT) was performed in the three of five studies where CT findings did not show typical findings of RCC [2–4]. Herein, we report a case of follicular thyroid carcinoma (FTC) metastasized to the kidney only, diagnosed by I-131 WBS mimicking RCC on CECT.
Case report A 76-year-old woman with known well-differentiated FTC was seen in October 2007 because of a palpable neck mass. Over a 1-year follow-up period, she had I-131 therapy three times: once for ablation therapy (1.1 GBq of I-131) and twice for empiric therapy (3.7 GBq of I-131) due to elevated serum thyroglobulin (TG) levels, a sensitive marker for recurrent DTC. Her TG level without thyroxine treatment was 3,238 ng/ml at the time of first iodine ablation
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