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Lung nodule detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid cancer, negative 131I whole body scan, and undetectable serum-stimulated thyroglobulin levels: two case reports

Chan-Hee Jung1, Hyeon-Jeong Goong1, Bo-Yeon Kim1, Jung-Mi Park2, Jeong-Ja Kwak3, Chul-Hee Kim1, Hyun-Sook Hong4, Sung-Koo Kang1 and Ji-Oh Mok15*

Author Affiliations

1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Soonchunhyang University School of Medicine, Bucheon, Korea

2 Department of Nuclear medicine, Soonchunhyang University School of Medicine, Bucheon, Korea

3 Department of Pathology, Soonchunhyang University School of Medicine, Bucheon, Korea

4 Department of Radiology, Soonchunhyang University School of Medicine, Bucheon, Korea

5 Division of Endocrinology and Metabolism, Soonchunhyang University School of Medicine, #108 Jung-Dong, Wonmi-Ku, Bucheon, Kyunggi-Do, 110-746, Korea

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Journal of Medical Case Reports 2012, 6:374  doi:10.1186/1752-1947-6-374

Published: 31 October 2012

Abstract

Introduction

When a pulmonary nodular lesion is detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography in a patient with post-surgical papillary thyroid carcinoma with undetectable serum-stimulated thyroglobulin levels and negative 131I whole body scan, diagnosis and management of the nodule may be confusing.

Case presentation

We describe two post-surgical patients with papillary thyroid carcinoma who showed pulmonary nodular lesions detected by F-18 fluorodeoxyglucose positron emission tomography-computed tomography. In both cases serum-stimulated thyroglobulin levels were undetectable and nodular lesions were not detected by 131I whole body scan. In the first case, a 64-year-old Asian woman showed one focal increased fluorodeoxyglucose uptake lesion in the right lower lobe of one of her lungs. Based on the histologic study, the pulmonary nodular lesion was diagnosed as a solitary pulmonary metastasis from papillary thyroid carcinoma. In the second case, a 59-year-old Asian woman showed a new pulmonary nodule in the right lower lobe. The computed tomography scan of her chest revealed a 9mm nodule in the anterior basal segment and another tiny nodule in the posterior basal segment of the right lower lobe. Six months later, both nodules had increased in size and miliary disseminated nodules were also seen in both lungs. Based on their histology, the pulmonary nodular lesions were considered to be primary lung adenocarcinoma.

Conclusions

The present cases emphasize that physicians should be cautious and make efforts for an accurate diagnosis of pulmonary nodules detected on F-18 fluorodeoxyglucose positron emission tomography-computed tomography in patients with papillary thyroid carcinoma with no evidence of metastasis such as negative 131I whole body scan and undetectable stimulated serum thyroglobulin levels.

Keywords:
F-18 fluorodeoxyglucose positron emission tomography-computed tomography; Papillary thyroid carcinoma; Pulmonary nodule; 131I whole body scan