Abstract
A 56-year-old male patient underwent total thyroidectomy, and pathology revealed multicentric papillary thyroid cancer. His post-operative stimulated thyroglobulin value was >500 ng/mL. 18F-fluorodeoxyglucose positron emission tomography (PET) computed tomography revealed hypermetabolic metastatic pulmonary nodules, cervical, and mediastinal lymph nodes. There was also a hypermetabolic lesion in the left gluteal muscle. Due to the patient’s history of a pilonidal cyst in the same region, the possibility of an abscess was also considered, and due to the absence of radioactive iodine (RAI) uptake in the lesion, follow-up was deemed appropriate. During follow-up, as the patient progressed to RAI-refractory state, 68Ga-DOTATATE PET/magnetic resonance imaging, which was done for radionuclide therapy planning, revealed heterogeneously increased uptake in the gluteal lesion. A subsequent biopsy confirmed the diagnosis of thyroid cancer metastasis.
Keywords:
PET/MRI, FDG, 68Ga DOTATATE, thyroid cancer, muscle, metastasis
Ethics
Informed Consent: Informed consent was obtained from the patient for the use of their imaging data.
Authorship Contributions
Surgical and Medical Practices: A.K., Concept: A.K., S.A., L-U.B., M.Ö., S.S., K.S., H.B.S., Design: A.K., S.A., Data Collection or Processing: A.K., S.A., L-U.B., M.Ö., S.S., K.S., H.B.S., Analysis or Interpretation: A.K., S.A., L-U.B., M.Ö., S.S., K.S., H.B. S., Literature Search: A.K., Writing: A.K.
Conflict of Interest: No conflicts of interest were declared by the authors.
Financial Disclosure: The authors declare that this study has received no financial support.
References
1Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1-133.
2Haslerud T, Brauckhoff K, Reisæter L, Küfner Lein R, Heinecke A, Varhaug JE, Biermann M. F18-FDG-PET for recurrent differentiated thyroid cancer: a systematic meta-analysis. Acta Radiol. 2016;57:1193-1200.
3Manohar PM, Beesley LJ, Bellile EL, Worden FP, Avram AM. Prognostic value of FDG-PET/CT metabolic parameters in metastatic radioiodine-refractory differentiated thyroid cancer. Clin Nucl Med. 2018;43:641-647.
4Roll W, Riemann B, Schäfers M, Stegger L, Vrachimis A. 177Lu-DOTATATE Therapy in radioiodine-refractory differentiated thyroid cancer: a single center experience. Clin Nucl Med. 2018;43:e346-e351.
5Vrachimis A, Stegger L, Wenning C, Noto B, Burg MC, Konnert JR, Allkemper T, Heindel W, Riemann B, Schäfers M, Weckesser M. [(68)Ga]DOTATATE PET/MRI and [(18)F]FDG PET/CT are complementary and superior to diffusion-weighted MR imaging for radioactive-iodine-refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2016;43:1765-1772.
6Versari A, Sollini M, Frasoldati A, Fraternali A, Filice A, Froio A, Asti M, Fioroni F, Cremonini N, Putzer D, Erba PA. Differentiated thyroid cancer: a new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients. Thyroid. 2014;24:715-726.
7UpToDate. https://www.uptodate.com/contents/papillary-thyroid-cancer-clinical-features-and-prognosis (2025, accessed February 2025)
8Herbowski L. Skeletal muscle metastases from papillary and follicular thyroid carcinomas: An extensive review of the literature. Oncol Lett. 2018;15:7083-7089.
