Adrenocortical Oncocytic Carcinoma and Papillary Thyroid Carcinoma Incidentally Detected in an Asymptomatic Patient by F-18 FDG PET/CT

Document Type : Case report

Authors

1 Dubai nuclear Medicine and Molecular imaging Center, Dubai Hospital, Dubai Health Authority, Dubai-UAE

2 Department of Urology, Dubai Hospital, Dubai Health Authority, Dubai-UAE

3 Department of Oncology, Dubai Hospital, Dubai Health Authority, Dubai-UAE

4 Dubai Nuclear Medicine and Molecular imaging Center, Dubai Hospital, Dubai Health Authority, Dubai-UAE

5 Department of Pathology and Genetics, Dubai Hospital, Dubai Health Authority, Dubai, UAE

6 Department of Pathology and genetics, Dubai hospital, Dubai Heath Authority, Dubai, UAE

Abstract

F-18 FDG is the most widely used tracer in molecular imaging and it is applied for many purposes mainly in malignant diseases. Incidental finding are common in FDG-PET/CT imaging and includes benign and malignant lesions. Among the rare tumors , adrenal oncocytomas are uncommon findings and incidental findings of thyroid malignancies are not rare. Oncocytoma is a rare adrenocortical tumor and majority of bulky adrenal tumors are benign with uncertain incident of malignancy. In this study, we are reporting a 37-year-old man with two incidental malignancies detected by FDG-PET-CT. He has no symptoms has no blood and hormonal abnormalities. The scan demonstrated intense heterogeneous FDG uptake within the bulky oval shaped lesion in the left adrenal gland. Accordingly, open adrenalectomy was performed and diagnosis of adrenocortical carcinoma oncocytic type was established. Furthermore, a focal FDG uptake was identified in the right thyroid lobe and histopathology findings were consistent with well-differentiated papillary thyroid cancer. FDG plays a great role in identifying primary rare lesions and also detection of incidental findings at unexpected sites.

Keywords

Main Subjects


  1. Hong Y, Hao Y, Hu J, Xu B, Shan H, Wang X. Adrenocortical oncocytoma: 11 case reports and review of the literature. Medicine. 2017;96(48):e8750.
  2. Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med. 2001;42(12):1795-9.
  3. Launay N, Silvera S, Tenenbaum F, Groussin L, Tissier F, Audureau E, et al. Value of 18-F-FDG PET/CT and CT in the diagnosis of indeterminate adrenal masses. Int J Endocrinol. 2015;2015:213875.
  4. Agrawal K, Weaver J, Ul-Hassan F, Jeannon JP, Simo R, Carroll P, et al. Incidence and significance of incidental focal thyroid uptake on 18F-FDG PET study in a large patient cohort: retrospective single-centre experience in the United Kingdom. Eur Thyroid J. 2015;4(2):115-22.
  5. Oishi S, Sasaki M, Sato T, Isogai M. Coexistence of MEN 2A and papillary thyroid carcinoma and a recurrent pheochromocytoma 23 years after surgery: report of a case and a review of the Japanese literature. Jpn J Clin Oncol. 1995;25(4):153-8.
  6. Bugalho MJ, Silva AL, Domingues R. Coexistence of paraganglioma/pheochromocytoma and papillary thyroid carcinoma: a four-case series analysis. Fam Cancer. 2015;14(4):603-7.
  7. Sisson JC, Giordano TJ, Avram AM. Three endocrine neoplasms: an unusual combination of pheochromocytoma, pituitary adenoma, and papillary thyroid carcinoma. Thyroid. 2012;22(4):430-6.
  8. Wanta SM, Basina M, Chang SD, Chang DT, Ford JM, Greco R, et al. A rare case of an aldosterone secreting metastatic adrenocortical carcinoma and papillary thyroid carcinoma in a 31-year-old male. Rare Tumors. 2011;3(4):e45.
  9. Podetta M, Pusztaszeri M, Toso C, Procopiou M, Triponez F, Sadowski SM. Oncocytic adrenocortical neoplasm with concomitant papillary thyroid cancer. Front Endocrinol. 2017;8:384.

10. Ginzburg S, Reddy M, Veloski C, Sigurdson E, Ridge JA, Azrilevich M, et al. Papillary thyroid carcinoma metastases presenting as ipsilateral adrenal mass and renal cyst. Urol Case Rep. 2015;3(6):221-2.

11. Koutkia P, Safer JD. Adrenal metastasis secondary to papillary thyroid carcinoma. Thyroid. 2001;11(11):1077-9.

12. Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med. 2001; 42(12):1795-9.

13. Launay N, Silvera S, Tenenbaum F, Groussin L, Tissier F, Audureau E, et al. Value of 18-F-FDG PET/CT and CT in the diagnosis of indeterminate adrenal masses. Int J Endocrinol. 2015;2015:213875.

14. Bertagna F, Treglia G, Piccardo A, Giovannini E, Bosio G, Biasiotto G, et al. F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value. Endocrine. 2013;43(3):678-85.

15. Algin E, Uner A, Akdemir UO, Gumusay O, Kapucu O, Ozet A. The assessment of incidental thyroid lesions on 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A single center experience. J Oncol Sci. 2017;3(2):57-61.

16. Nockel P, Millo C, Keutgen X, Klubo-Gwiezdzinska J, Shell J, Patel D, et al. The rate and clinical significance of incidental thyroid uptake as detected by gallium-68 DOTATATE positron emission tomography/computed tomography. Thyroid. 2016;26(6):831-5.