|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 2 | Page : 92-94
Rare renal metastasis from a follicular carcinoma thyroid and its evaluation
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
|Date of Web Publication||1-Jun-2016|
Dr. Arvind Krishnamurthy
Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Adyar, Chennai - 600 036, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishnamurthy A. Rare renal metastasis from a follicular carcinoma thyroid and its evaluation. Thyroid Res Pract 2016;13:92-4
Renal metastasis of thyroid carcinomas is a rare occurrence and represents about 3% of all metastases to the kidney.,,,, A great majority of the cases were reported in women over 45 years. We report an additional case of a renal metastasis from a follicular carcinoma thyroid in a 23-year-old female with an added emphasis on the issues pertaining to its diagnosis and evaluation.
A 23-year-old female underwent an uneventful total thyroidectomy for a follicular carcinoma thyroid (3 cm complex nodule). Her postoperative serum thyroglobulin was 191 ng/ml and the postoperative whole body iodine-131 (I-131) scans showed uptakes in the sternum, right side of ribs, lumbar 5 (L5) vertebra apart from an intense uptake in the right side of her abdomen [Figure 1]. The activity in the right side of the abdomen was localized to 2.5 cm × 2.5 cm lesion in the upper pole of the right kidney as delineated in a subsequent single photon emission computed tomography (SPECT) [Figure 2] and a CT scan of the abdomen and pelvis [Figure 3]. A diagnosis of synchronous renal metastasis alongside multiple bony metastases from a follicular carcinoma thyroid was made. The radioiodine concentration in renal and multiple sites of bony metastases made it amenable to high-dose radioiodine therapy. The option of metastasectomy (partial nephrectomy), although less understood in setting of multiple metastases was discussed with the patient after the resolution of the bony metastasis following two ablative doses (each 120 millicuries) with radioactive I-131 [Figure 4]. The patient however being asymptomatic wished to follow-up and is presently on thyroxine suppression for close to 2 years following her initial surgery. She is being planned for further radioiodine therapy.
|Figure 1: 2 mCi whole body iodine-131 scan (anterior and posterior views) scans showed uptakes in the residual thyroid in the neck. Uptakes were also seen in the sternum, right side of ribs, lumbar 5 vertebra apart from an intense uptake in the right side of her abdomen|
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|Figure 2: A single photon emission computed tomography study of the abdomen revealed functioning metastases in the right side of abdomen probably renal metastases|
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|Figure 3: A corresponding computed tomography scan of the abdomen revealed a well-defined contrast enhancing mass lesion in the upper pole of the right kidney measuring 2.5 cm × 2.5 cm. Also noted was the lytic lesion in the body of the lumbar 5 vertebra|
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|Figure 4: An iodine-131 whole body scan (anterior and posterior views) done after the second ablation (after close to 2 years following thyroidectomy) revealed uptakes in the right kidney|
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The major sites of distant metastases from differentiated thyroid cancers (DTCs) are the lung and bone, renal metastasis from a thyroid carcinoma is rare with only about 23 cases being reported in the English language literature. Renal metastasis can, in fact, occur in various settings, metastasis presenting as a presumed primary renal tumor has been reported, on the other hand, renal metastasis developing several years/decades after removal of the primary thyroid cancer have also been reported.
Our case primarily highlights the need for a high degree of suspicion of renal metastasis in the event of an intense uptake in the abdomen in an I-131 whole body scan.,,,,, The findings in our patient were confirmed on a subsequent SPECT (metabolic) and a CT scan (anatomic) done sequentially. An I-131 integrated fusion SPECT/CT scan can in fact better provide both the metabolic as well as the anatomic information about a lesion and therefore can be used to better localize and confirm the I-131 scan findings in patients with DTCs. In conclusion, the increasing use of I-131 and I-131 SPECT/CT scans can potentially identify unusual sites of metastases and recognizing these metastases can impact the clinical decision making and prognosis in patients with metastatic DTCs.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]