Papillary thyroid cancer with metastases to brain, lung and kidney: A case of dosimetry proven privilege of surgical resection of organ metastases

Abstract

A 45-year-old woman presented with a headache and visual complaints. Brain MRI revealed a large mass in the right occipital cortex. The tumor was surgically removed and pathological examination showed papillary carcinoma originating from thyroid gland. She had a history of thyroid surgery 27 years ago indicating papillary thyroid cancer with central neck lymph node involvement followed by no additional treatments. CT scan showed a mass in the right kidney and multiple liver cysts. She was referred and treated with curative dose of radioiodine. A post therapeutic iodine scan showed accumulation of the tracer in the right kidney and disseminated uptake in the lungs and neck, with no focal uptake in the liver. To increase iodine accumulation in the lungs with curative intention, the right kidney was surgically resected. Forty-five days after nephrectomy, the patient received her second dose of radioiodine. In the second post therapy scan, the uptake in the lungs and neck was significantly enhanced. The ratio of lungs to whole body uptake was 17.2% and 46.2% in the first and second post therapeutic scan, respectively. Not only unilateral kidney metastasis from PTC is rare incidentally noticed non-metastatic multiple liver cysts in this patient are interesting to report, also the benefit from metastasectomy of asymptomatic visceral metastasis is documented. Such a visceral metastasectomy could result in optimal radiation to other sites, being lung metastases in this case.