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A rare case of thyroid paraganglioma detected by 18F-FDG PET/CT
Un caso raro de paraganglioma tiroideo detectado con 18F-FDG PET/TC
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"apellidos" => "Sanmartin" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914001001?idApp=UINPBA00004N" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914001001/v1_201408200020/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images of interest</span>" "titulo" => "A rare case of thyroid paraganglioma detected by <span class="elsevierStyleSup">18</span>F-FDG PET/CT" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "320" "paginaFinal" => "321" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Giorgio Treglia, Luca Giovanella, Carmelo Caldarella, Francesco Bertagna" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Giorgio" "apellidos" => "Treglia" "email" => array:1 [ 0 => "giorgiomednuc@libero.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luca" "apellidos" => "Giovanella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carmelo" "apellidos" => "Caldarella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Francesco" "apellidos" => "Bertagna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Nuclear Medicine, PET/CT Centre and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institute of Nuclear Medicine, Catholic University, Rome, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Chair of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso raro de paraganglioma tiroideo detectado con <span class="elsevierStyleSup">18</span>F-FDG PET/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 924 "Ancho" => 1500 "Tamanyo" => 187809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole-body maximum intensity projection <span class="elsevierStyleSup">18</span>F-FDG PET image (A), PET (B1, C1, D1), CT (B2, C2, D2) and fused PET/CT images (B3, C3, D3) in axial (B1–3), coronal (C1–3) and sagittal projection (D1–3) showing a focal area of increased radiopharmaceutical uptake corresponding to a 4<span class="elsevierStyleHsp" style=""></span>cm nodule located in the right thyroid lobe (red arrows) with a SUVmax of 9. No other areas of abnormal <span class="elsevierStyleSup">18</span>F-FDG uptake were evident in the rest of the body.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Text</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old female patient with history of ovarian cancer underwent Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography (<span class="elsevierStyleSup">18</span>F-FDG PET/CT) for restaging due to increasing serum tumor markers levels (CA-125: 40<span class="elsevierStyleHsp" style=""></span>U/ml). Before <span class="elsevierStyleSup">18</span>F-FDG injection, the patient had fasted for at least 6<span class="elsevierStyleHsp" style=""></span>h; at the time of the radiopharmaceutical injection, she presented glucose blood levels corresponding to 93<span class="elsevierStyleHsp" style=""></span>mg/dL. Images were acquired 1<span class="elsevierStyleHsp" style=""></span>h after intravenous injection of 260<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">18</span>F-FDG according to the body mass index. The unenhanced CT scan performed from the skull base to the inguinal region was used for the anatomic localization and the attenuation correction of PET data. PET images were evaluated visually and semi-quantitatively (by using the maximum standardized uptake value [SUV<span class="elsevierStyleInf">max</span>]).</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET/CT showed a focal area of increased radiopharmaceutical uptake corresponding to a 4<span class="elsevierStyleHsp" style=""></span>cm nodule located in the right thyroid lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No other areas of abnormal radiopharmaceutical uptake were detected in the rest of the body. Based on this PET/CT finding, the patient underwent fine needle aspiration biopsy which was suspicious for malignancy. Therefore she underwent total thyroidectomy and subsequent histology showed features consistent with paraganglioma. At hematoxylin and eosin staining, clearly delimited and highly vascular neoplastic lesions were composed of cell balls (chief cells and sustentacular cells) separated by thin fibrous septa. At immunohistochemistry, neoplastic chief cells expressed chromogranin, synaptophysin, neuron-specific enolase and CD56, whereas the sustentacular cells were highlighted by S100 protein.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the absence of metastatic lesions demonstrated by <span class="elsevierStyleSup">18</span>F-FDG PET/CT and negative somatostatin receptor imaging performed after thyroidectomy, the patient was addressed to follow-up.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thyroid paraganglioma is an extremely rare tumor and frequently mistaken for other thyroid hypervascular neoplasms. Increased awareness of its potential presentation in thyroid and its characteristic features is essential for avoiding diagnostic and therapeutic pitfalls. Radiological examinations are often nonspecific and accurate diagnosis relies on the histopathogical findings and adjunctive immunohistochemical studies. To date, all the cases reported in the literature have demonstrated a benign course.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Focal incidental uptake in the thyroid is observed in about 2% of <span class="elsevierStyleSup">18</span>F-FDG PET scans carrying a significant risk of malignancy. Most of the malignant lesions (about one-third of cases) are well-differentiated thyroid carcinomas. Therefore, further investigation is warranted whenever focal incidental <span class="elsevierStyleSup">18</span>F-FDG uptake is detected in the thyroid.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our case <span class="elsevierStyleSup">18</span>F-FDG PET/CT has been very useful in detecting and staging a rare neuroendocrine tumor of the thyroid gland, excluding other sites of disease. Due to the variable <span class="elsevierStyleSup">18</span>F-FDG uptake in neuroendocrine tumors, which are often low-growth neoplasms with low glucose metabolism, it could not be assumed that a thyroid paraganglioma presents <span class="elsevierStyleSup">18</span>F-FDG avidity in all cases. Other more specific tracers such as fluorine-18-dihydroxyphenylalanine (<span class="elsevierStyleSup">18</span>F-DOPA) and radiolabelled somatostatin analogs, evaluating the dopaminergic metabolism and the somatostatin receptor expression, respectively, could be very useful in patients with cervical paraganglioma.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Text" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-14" "fechaAceptado" => "2013-11-22" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 924 "Ancho" => 1500 "Tamanyo" => 187809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole-body maximum intensity projection <span class="elsevierStyleSup">18</span>F-FDG PET image (A), PET (B1, C1, D1), CT (B2, C2, D2) and fused PET/CT images (B3, C3, D3) in axial (B1–3), coronal (C1–3) and sagittal projection (D1–3) showing a focal area of increased radiopharmaceutical uptake corresponding to a 4<span class="elsevierStyleHsp" style=""></span>cm nodule located in the right thyroid lobe (red arrows) with a SUVmax of 9. No other areas of abnormal <span class="elsevierStyleSup">18</span>F-FDG uptake were evident in the rest of the body.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary paraganglioma of thyroid gland: a clinicopathologic and immunohistochemical analysis of three cases with a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.H. Yu" 1 => "W.Q. Sheng" 2 => "J. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12105-013-0467-7" "Revista" => array:6 [ "tituloSerie" => "Head Neck Pathol" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "373" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23943066" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Bertagna" 1 => "G. Treglia" 2 => "A. Piccardo" 3 => "R. Giubbini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2012-2390" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2012" "volumen" => "97" "paginaInicial" => "3866" "paginaFinal" => "3875" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22904176" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focal thyroid incidental uptake detected by <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Treglia" 1 => "F. Bertagna" 2 => "R. Sadeghi" 3 => "F.A. Verburg" 4 => "L. Ceriani" 5 => "L. Giovanella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3413/Nukmed-0568-13-03" "Revista" => array:6 [ "tituloSerie" => "Nuklearmedizin" "fecha" => "2013" "volumen" => "52" "paginaInicial" => "130" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23765102" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914001013/v1_201408200020/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003300000005/v1_201408200020/S2253808914001013/v1_201408200020/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914001013?idApp=UINPBA00004N" ]
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