The Rare case of coexistence cervical lymph node metastasis of papillary thyroid carcinoma and cervical ganglioneuroma-possibility of radioiodine refractory thyroid cancer misdiagnosis?

Vesna Ignjatović; Katarina Vuleta Nedić; Vladimir Vukomanovic; Ana Ranković; Svetlana Kocić

doi:10.5937/afmnai41-47259

Vesna Ignjatović Univerzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za nuklearnu medicinu i kliničku onkologiju, Kragujevac, Srbija
Katarina Vuleta Nedić 1Department for Nuclear Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
Vladimir Vukomanovic 1Department for Nuclear Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
Ana Ranković 2 Department of Radiology, University Clinical Center Kragujevac, Kragujevac, Serbia.
Svetlana Kocić 3Department of Radiology, Clinical Hospital Center Zemun, Belgrade, Serbia

DOI: https://doi.org/10.5937/afmnai41-47259

Keywords: radiojodna terapija, dobro diferentovani karcinom štitaste žlezde refraktorni na radiojodnu terapiju, ganglioneurinom

Abstract

Uvod. Dobro diferentovani karcinomi štitaste žlezde se kod većine pacijenata uspešno leče primenom adekvatne hirurške procedure, radiojodnom terapijom i supresijom sekrecije tireoidno stimulišućeg hormona (TSH). Međutim, u 15% slučajeva se tokom kliničkog praćenja detektuju lokoregionalne i udaljene metastaze. Oko dve trećine ovakvih slučajeva postaje rezistentno na radiojodnu terapiju, entitet poznat kao “Dobro diferentovani karcinomi štitaste žlezde refraktorni na radiojodnu terapiju”, koji ima lošu prognozu i ograničene terapijske mogućnosti. Želimo da prikažemo slučaj pogrešno postavljene sumnje na radiojodnu refraktornost usled incidentalnog nalaza koegzistirajućeg cervikalnog ganglioneurinoma.

Prikaz slučaja. 44-godišnjem muškarcu je u našem odeljenju aplikovana druga doza radiojoda zbog postojanja lokoregionalnih metastatskih limfnih čvorova papilarnog karcinoma štitaste žlezde. Tokom kliničkog praćenja, rastući trend tireoglobulina u uslovima TSH supresije, negativna dijagnostička scintigrafija celog tela sa ¹³¹I i negativna pozitronska emisiona tomografija/kompjuterizovana tomografija sa ¹⁸F-fluorodeoksiglukozom (¹⁸F-FDG PET/CT) su pobudili sumnju na postojanje “Dobro diferentovanog karcinoma štitaste žlezde refraktornog na radiojodnu terapiju”. Iako se razmatralo sprovođenje peptid-receptor radionuklidne terapije (PRRT), najpre zbog pozitivnog nalaza u vratu pacijenta na ^99mTc-Hynic-TOC imidžingu (Tektrotyd scan), nakon dodatne morfološke dijagnostike, prednost je data hirurškoj terapijskoj proceduri. Histopatolški nalaz uklonjene tumorske mase u vratu je potvrdio prisustvo jednog metastatkog limfnog čvora papilarnog karcinoma štitaste žlezde i koegzistirajućeg ganglioneurinoma.

Zaključak. Autori žele da ukažu na značaj multidisciplinarnog pristupa u dijagnostici i terapiji kod postojanja sumnje na gubitak svojstva diferencijacije dobro diferentovanih karcinoma štitaste žlezde, kao i na značaj svesnosti kliničara o postojanju asimptomatskih retkih tumora.

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