[Differentiated thyroid gland carcinoma in a scintigraphically hot thyroid nodule: diagnosis and interdisciplinary therapeutic management].
A hyperfunctioning differentiated thyroid carcinoma is a rare occurrence. Nevertheless, this diagnosis must be considered in a scintigraphically hot nodule if there is a clinical or sonographic suggestion of malignancy. The case of a 57-year old patient with hyperthyreosis and a scintigraphically hot thyroid nodule is presented. Further evaluation led to the diagnosis of a differentiated thyroid carcinoma with extensive lymph node and pulmonary metastases (pT2b, pN1b, pM1). The scintigraphically hot nodule corresponded to the primary tumor, whereas scintigraphic detection of the lymph node metastases was only possible postoperatively. Extensive resection of the lymph node metastases was achieved by the intraoperative application of a gamma probe (2nd operation). This allowed sufficient uptake of radioiodine in the pulmonary metastases for their detection and subsequent devitalisation by radioiodine therapy. Complete elimination of all tumour tissue was documented at a control follow-up after six months. Gamma probe-guided surgery may allow for additional removement of non-palpable lymph node metastases. In selected cases this may optimize the surgical results and thereby facilitate the subsequent radioiodine elimination of advanced differentiated thyroid carcinomas.
Stahl
Alexander
A
Nuklearmedizinische Klinik und Poliklinik der TU München, Klinikum rechts der Isar, München, Deutschland.
Hess
Ulrich
U
Harms
Jens
J
Zwicknagl
Martina
M
Langhammer
Heinz
H
D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D002231:Carbimazole / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D006980:Hyperthyroidism / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011877:Radionuclide Imaging; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation / Q000379:methods; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D013965:Thyroidectomy; D014915:Whole-Body Counting
D007457:Iodine Radioisotopes; D002231:Carbimazole
Differenziertes Schilddrüsenkarzinom in einem szintigraphisch heissen Schilddrüsenknoten: Diagnostik und interdisziplinäres therapeutisches Vorgehen.