title: Normalization of lymphocyte count after high ablative dose of I-131 in a patient with chronic lymphoid leukemia and secondary papillary carcinoma of the thyroid. Case report.
abstract: The authors report the case of a 70-year-old male patient with chronic lymphoid leukemia who presented subsequently a papillary carcinoma of the thyroid with metastases to regional lymph nodes. The patient was treated with surgical thyroidectomy with regional and cervical lymph node excision and radioiodine therapy (I-131). The protocolar control scintigraphy 4 days after the radioactive dose showed I-131 uptake in both axillae and even in the inguinal regions. PET/CT showed faint FDG-F-18 uptake in one lymph node of the left axilla. An ultrasound guided fine needle biopsy of this lymph node identified by I-131 SPECT/CT and FDG-F-18 PET/CT revealed lymphoma cells and was negative for thyroid tissue and thyroglobulin content. The sequential blood counts done routinely after radiation treatment showed a marked fall until return to normal values of leucocytes and lymphocytes (absolute and relative), which were still normal in the last control 19 months after the radioiodine administration. Chest computed tomography showed a decrease in size of axillary and para-aortic lymph nodes. By immunohistochemistry, cells of the lymphoid B lineage decreased from 52% before radioiodine therapy to 5% after the procedure. The authors speculate about a possible sodium iodide symporter expression by the cells of this lymphoma, similar to some other non-thyroid tumors, such as breast cancer cells.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Anneliese Rosmarie Gertrud Fischer
authors.initials: AR
authors.lastname: Thom
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Hamerschlak
authors.affiliation: Sociedade Brasileira de Diabetes, São Paulo, SP, Brazil.
authors.forename: Verônica Goes
authors.initials: VG
authors.lastname: Teles
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Akemi
authors.initials: A
authors.lastname: Osawa
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Fabio Pires de Souza
authors.initials: FP
authors.lastname: Santos
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Denise da Cunha
authors.initials: Dda C
authors.lastname: Pasqualin
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Jairo
authors.initials: J
authors.lastname: Wagner
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Lilian Yuri Itaya
authors.initials: LY
authors.lastname: Yamaga
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcelo Livorsi da
authors.initials: ML
authors.lastname: Cunha
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Guilherme de Carvalho
authors.initials: Gde C
authors.lastname: Campos Neto
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcelo Buarque de Gusmão
authors.initials: MB
authors.lastname: Funari
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D002291:Carcinoma, Papillary; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D053685:Laser Therapy / Q000379:methods*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000473:pathology; D018655:Lymphocyte Count; D008297:Male; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes
references.citation: Surg Today. 2004;34(5):440-3
references.pmid: 15108084
references.citation: JAMA. 1975 Apr 21;232(3):267-9
references.pmid: 47401
references.citation: J Clin Oncol. 2001 Oct 1;19(19):3918-28
references.pmid: 11579112
references.citation: Wien Klin Wochenschr. 2006 Mar;118(3-4):124-7
references.pmid: 16703258
references.citation: Diagn Cytopathol. 2008 Nov;36(11):813-7
references.pmid: 18831028
references.citation: Br J Cancer. 2011 Sep 27;105(7):1076-81
references.pmid: 21847118
references.citation: J Natl Cancer Inst. 1992 Sep 16;84(18):1422-7
references.pmid: 1512794
references.citation: Thyroid. 2009 Apr;19(4):417-9
references.pmid: 19355833
references.citation: Ann Surg Oncol. 2009 Apr;16(4):962-8
references.pmid: 19184238
references.citation: Surg Today. 2007;37(4):311-5
references.pmid: 17387564
references.citation: MedGenMed. 2007 Nov 15;9(4):35
references.pmid: 18311385
references.citation: Endocr Rev. 2003 Feb;24(1):48-77
references.pmid: 12588808
references.citation: Blood. 2001 Sep 15;98(6):1979-81
references.pmid: 11535538
references.citation: Eur J Haematol. 1994 Oct;53(4):218-22
references.pmid: 7957806
references.citation: J Nucl Med. 2003 Nov;44(11):1827-38
references.pmid: 14602867
references.citation: Pol J Pathol. 2004;55(3):23-30
references.pmid: 15619977
references.citation: Cancer. 1996 Dec 1;78(11):2421-6
references.pmid: 8941014