Fortuitous Discovery Of Non-Fluorocholine-Fixing Papillary Carcinoma Of Vesicular Variant Of The Thyroid

  • Purpose: Characterization of thyroid nodules is crucial in order to propose surgical intervention for histological verification. Cervical ultrasound potentially combined with fine needle aspiration is recommended, and fluorocholine positron emission tomography (FCH-PET), commonly used in prostatic cancers, has been evaluated in the diagnosis of thyroid cancers in recent publications.

    Methods: We present two cases of patients with multinodular thyroid and primary hyperparathyroidism. The preoperative assessment consisted of an ultrasound, a MIBI scintigraphy and a FCH-PET in favor of a parathyroid adenoma.

    Results: The imaging examinations pointed to a diagnosis of a parathyroid adenoma. In both cases, papillary thyroid carcinoma, missed by FCH-PET, was discovered incidentally at a distance from the parathyroid adenoma during the surgical procedure.

    Discussion:
    Incidental thyroid fixations have been demonstrated in few cases that raised some discussion of its use as an imaging option to diagnose thyroid cancers. 18F-FCH PET/CT is an approved imaging test to localize precisely the parathyroid adenomas, especially in cases were adenomas identification by cervical ultrasound and scintigraphy-MIBI are impossible. However, its place in the assessment of nodular dystrophies or thyroid cancers is not yet clearly defined.

    Conclusions: These are the first descriptions of thyroid papillary carcinoma without preoperative FCH-PET identification. These clinical cases are contrary to recent publications showing a benefit of this examination in the diagnosis of thyroid cancers.

 

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