Edamadaka Yeshwanth, Parghane Rahul V, Basu Sandip
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Homi Bhabha National Institute, Mumbai, Maharashtra, India.
World J Nucl Med. 2024 Jun 14;23(3):220-224. doi: 10.1055/s-0044-1787732. eCollection 2024 Sep.
We herein present a patient initially suspected of multiple lytic skeletal metastasis of unknown primary on anatomical imaging. Metabolic imaging by [18F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) detected focal [18F]FDG uptake in the right thyroid nodule, mild [18F]FDG uptake in soft tissue lesion in the left inferior parathyroid region, and multiple nonavid osteolytic skeletal lesions. Fine-needle aspiration cytology of the right thyroid nodule showed papillary thyroid carcinoma (PTC). The patient had raised serum parathyroid hormone and serum calcium levels, suggesting parathyroid disease. [18F]-sodium fluoride (NaF)-PET/CT showed a metabolic superscan pattern of hyperparathyroidism with brown tumors rather than metastatic lytic skeletal lesions. Patient underwent total thyroidectomy and bilateral central compartment clearance, along with soft tissue lesion resection in the left inferior parathyroid region. Finally, histopathology confirmed PTC classical variant with no aggressive histology features (pT1N0) for thyroid nodule and parathyroid adenoma for soft tissue lesion in the left inferior parathyroid region. The findings of the [18F]FDG and [18F]NaF-PET/CT imaging were helpful for making a final diagnosis of synchronous thyroid cancer and parathyroid adenoma, which in turn guided the appropriate treatment strategy.
我们在此报告一名患者，其在解剖学影像上最初被怀疑为原发灶不明的多发性溶骨性骨转移。通过[18F] - 氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）进行的代谢成像检测到右甲状腺结节有局灶性[18F]FDG摄取，左甲状旁腺区域软组织病变有轻度[18F]FDG摄取，以及多个无摄取的溶骨性骨病变。右甲状腺结节的细针穿刺细胞学检查显示为甲状腺乳头状癌（PTC）。患者血清甲状旁腺激素和血清钙水平升高，提示甲状旁腺疾病。[18F] - 氟化钠（NaF）-PET/CT显示甲状旁腺功能亢进伴棕色瘤的代谢性超级扫描模式，而非转移性溶骨性骨病变。患者接受了全甲状腺切除术和双侧中央区清扫，以及左甲状旁腺区域软组织病变切除术。最后，组织病理学证实甲状腺结节为无侵袭性组织学特征的PTC经典型（pT1N0），左甲状旁腺区域软组织病变为甲状旁腺腺瘤。[18F]FDG和[18F]NaF - PET/CT成像结果有助于对同步性甲状腺癌和甲状旁腺腺瘤做出最终诊断，进而指导了适当的治疗策略。
