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Nuklearmedizin
DOI: 10.1055/a-2273-2447
Case Report

Divergent growth on [18F]FDG PET/CT in a case of co-existing pulmonary metastatic leiomyosarcoma and papillary thyroid carcinoma

Divergentes Wachstum im [18F]FDG-PET/CT bei einem Fall von pulmonal metastasiertem Leiomyosarkom und papillärem Schilddrüsenkarzinom
Sean Ira G. Gacula‡
1   Department of Medical Imaging and Therapeutic Radiology, National Kidney and Transplant Institute, Manila, Philippines
,
Sophie C. Kunte‡
2   Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
,
Lena M. Unterrainer
2   Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
,
Johannes Rübenthaler
3   Department of Radiology, University Hospital, LMU Munich, Munich, Germany
,
Wolfgang G. Kunz
3   Department of Radiology, University Hospital, LMU Munich, Munich, Germany
,
Clemens Cyran
3   Department of Radiology, University Hospital, LMU Munich, Munich, Germany
,
Adrien Holzgreve
2   Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
› Author AffiliationsSupported by: Bayerisches Zentrum für Krebsforschung (BZKF) to Adrien Holzgreve,to Lena M. Unterrainer
Supported by: Munich Clinician Scientist Program (MCSP) to Lena M. Unterrainer
Supported by: European School of Radiology (ESOR) to Sean Ira Gacula
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Correction: Divergent growth on [18F]FDG PET/CT in a case of co-existing pulmonary metastatic leiomyosarcoma and papillary thyroid carcinomaNuklearmedizin eFirst
DOI: 10.1055/a-2286-9571

Case / Introduction

We report on an 83-year-old man with suspected metastatic recurrence of a papillary thyroid carcinoma (PTC). Eleven years earlier, he underwent total thyroidectomy and radioactive iodine (RAI)-therapy (3.8 GBq) for remnant ablation (pT3,N0,M0,R0,L0,V0). Five years later, he underwent another cycle of RAI-therapy (7.4 GBq) due to increasing thyroglobulin level and suspicious lymph nodes on both sides of the carotid sheath upon sonography. Since on post-treatment scintigraphy no suspicious iodine uptake was noted, [18F]FDG-PET/CT was performed to rule out tumor de-differentiation [1]. PET/CT revealed a mildly increased metabolism in cervical lymph nodes but no clear evidence of local or distant tumor sites. Two years of continuous clinical follow-up later, the patient underwent another [18F]FDG-PET/CT-scan for mild increases of thyroglobulin levels and mild growth of cervical lymph nodes on sonography. [18F]FDG-PET/CT eventually revealed suspicious cervical lymph nodes, a new nodule with increased metabolism in the right upper lung (1.1×0.9 cm, arrow [Fig. 1]a) and further small lung nodules up to 0.5 cm, suspicious of pulmonary metastases of PTC. The multidisciplinary tumor board recommended lymph node dissection, next-generation-sequencing (NGS), and follow-up imaging of the pulmonary nodules. Four months later, follow-up [18F]FDG-PET/CT was performed and revealed a singular significant progression of the pulmonary mass in the right upper lobe (2.4×2.2 cm, [Fig. 1]b). A decision for a biopsy was made. Contrary to the initial suspicion of a pulmonary PTC metastasis, histopathology surprisingly revealed metastatic pulmonary leiomyosarcoma (LMS). Subsequent total-body [18F]FDG-PET/CT identified a lesion with an intense metabolic uptake involving the left vastus medialis muscle (SUVmax 11.2), consistent with the primary location of LMS (arrow on maximum-intensity-projection of current PET/CT in [Fig. 1] c; outside of the field-of-view of prior PET/CT-scans).



Publication History

Received: 08 February 2024

Accepted: 20 February 2024

Article published online:
11 March 2024

© 2024. Thieme. All rights reserved.

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