Bronchoalveolar carcinoma of lung masquerading as iodine avid metastasis in a patient with minimally invasive follicular carcinoma of thyroid.
A 52-year-old man with follicular thyroid carcinoma was administered 182 mCi of radioiodine (I-131) a month after total thyroidectomy. Post-therapy scan revealed diffuse uptake of radioiodine in the apical left lung. CT-guided biopsy of this mass revealed mucinous bronchoalveolar carcinoma. Immunohistochemistry for thyroglobulin was negative. An FDG PET scan showed avid uptake in the lung mass. Surgery was ruled out, so he was given chemotherapy, without benefit. The lesion continued to show I-131 uptake even while on daily T3 substitution, suggesting that the mass was thyroid stimulating hormone-independent. Because the mass showed I-131 uptake and chemotherapy was not beneficial, it was decided to treat with I-131. He was continued on T3 substitution therapy and was given 209 mCi of I-131. Follow-up CT scan a few weeks later reported a 1-cm all round reduction of the mass. I-131 scan showed avid tracer uptake in the mass. This case suggests the possibility of this therapeutic option in nonthyroidal tumors that may concentrate radioiodine.
Malhotra
Gaurav
G
Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Tata Memorial Hospital, Parel, Mumbai. maloonucmed@yahoo.com
Nair
Narendra
N
Menon
Hari
H
Gujral
Sumit
S
Abhyankar
Amit
A
Baghel
Nawab S
NS
Awasare
Sushama
S
Nabar
Swapna J
SJ
Abhyankar
Suman
S
Kand
Purushottam G
PG
D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000556:secondary*; D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D001706:Biopsy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
D007457:Iodine Radioisotopes