Download PDF
CC BY 4.0 · World J Nucl Med 2023; 22(01): 070-074
DOI: 10.1055/s-0042-1759615
Case Report

Hurthle Cell Thyroid Carcinoma with Liver and Paraaortic Abdominal Nodal Metastasis: Progression on Sorafenib Therapy after Initial Disease Stabilization

Sarvesh Loharkar
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Sandip Basu
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Hurthle cell thyroid carcinoma (HCTC) demonstrates inferior prognosis compared with other types of differentiated thyroid cancer (DTC), along with radioiodine refractoriness and relatively poor 131I concentrating ability. We herein report a case of a middle-aged lady presenting with neck swelling for years, who on pre-surgery work-up was diagnosed to harbor metastatic nodal and lung lesions. Post-thyroidectomy and neck dissection, she was diagnosed with HCTC. Post-surgery, none of the lesions concentrated radioactive-iodine (RAI) sufficiently but showed FDG avid lesions as mediastinal nodes, lung nodules, solitary lytic sternal lesions, and unusual bilateral paraaortic abdominal nodes. She was put on tyrosine kinase inhibitor (sorafenib) and showed disease stabilization for the initial 3 years, but multiple toxicity symptoms while on sorafenib therapy that needed multiple dose adjustments. Over the period of the subsequent year, she developed significant disease progression with liver involvement. She was shifted to lenvatinib, which she tolerated well. The functional imaging profile with unusual metastatic sites, the aggressive clinical presentation and disease course of RAI refractory HCTC over 4 years on tyrosine kinase inhibitor therapy, and the role of molecular FDG-PET/CT imaging in disease monitoring and clinical management of such case is presented.

Keywords

Hurthle cell thyroid carcinoma - 18F-FDG-PET/CT - tyrosine kinase inhibitors - para-arotic lymphadenopathy - sorafenib - lenvatinib - radioiodine-refractory

Authors' Contributions

Dr Sarvesh Loharkar and Dr Sandip Basu have given substantial contributions to the conception or the design of the manuscript. All authors have participated to drafting the manuscript and revised it critically. All authors read and approved the final version of the manuscript.




Publication History

Article published online:
20 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Goffredo P, Roman SA, Sosa JA. Hurthle cell carcinoma: a population-level analysis of 3311 patients. Cancer 2013; 119 (03) 504-511
    CrossrefPubMedGoogle Scholar
  • 2 Bhattacharyya N. Survival and prognosis in Hürthle cell carcinoma of the thyroid gland. Arch Otolaryngol Head Neck Surg 2003; 129 (02) 207-210
    CrossrefPubMedGoogle Scholar
  • 3 Liu JW, Chen C, Loh EW. et al. Tyrosine kinase inhibitors for advanced or metastatic thyroid cancer: a meta-analysis of randomized controlled trials. Curr Med Res Opin 2018; 34 (05) 795-803
    CrossrefPubMedGoogle Scholar
  • 4 Besic N, Schwarzbartl-Pevec A, Vidergar-Kralj B, Crnic T, Gazic B, Marolt Music M. Treatment and outcome of 32 patients with distant metastases of Hürthle cell thyroid carcinoma: a single-institution experience. BMC Cancer 2016; 16: 162
    CrossrefPubMedGoogle Scholar
  • 5 Meyer-Rochow GY, McMullen TP, Gill AJ, Sywak MS, Robinson BG. Intra-abdominal insular thyroid carcinoma metastasis. Thyroid 2009; 19 (05) 527-530
    CrossrefPubMedGoogle Scholar
  • 6 Hosoda K, Kusama K, Yanagisawa N. et al. Anaplastic transformation of thyroid cancer in mesentery metastases presenting as intestinal perforation: a case report. Surg Case Rep 2020; 6 (01) 194
    CrossrefPubMedGoogle Scholar
  • 7 Pryma DA, Schöder H, Gönen M, Robbins RJ, Larson SM, Yeung HW. Diagnostic accuracy and prognostic value of 18F-FDG PET in Hürthle cell thyroid cancer patients. J Nucl Med 2006; 47 (08) 1260-1266
    PubMedGoogle Scholar
  • 8 Yamazaki H, Sugino K, Matsuzu K. et al. Rapid disease progression after discontinuation of lenvatinib in thyroid cancer. Medicine (Baltimore) 2020; 99 (11) e19408
    CrossrefPubMedGoogle Scholar
  • 9 Aydemirli MD, Corver W, Beuk R. et al. Targeted treatment options of recurrent radioactive iodine refractory Hürthle cell cancer. Cancers (Basel) 2019; 11 (08) 1185
    CrossrefPubMedGoogle Scholar