Purpose:Papillary carcinoma is the most frequent type of thyroid cancer and was considered the most benign of all thyroid carcinomas, with a low risk of distant metastases. However, there are some variants of papillary thyroid carcinoma that have affinity to spread in many organs, such as: lymph nodes, lungs and bones.Aim:The aim of this study was presentation of a case with papillary carcinoma of the thyroid gland, very persistent and resistant in treatment with I 131.Material and results:A man 56 years old were diagnosed with papillary carcinoma of thyroid gland. He underwent a surgical removal of the tumor and right lobe of thyroid gland. With histopathology examination, were confirmed follicular variant of papillary carcinoma pT4. Two weeks later he underwent total thyroidectomy and was treated with 100 mCi of J 131. Six months later, the value of thyroglobulin was found elevated above upper measured limits (more than 500 ng/ml). Patient underwent surgical removal of 10 metastatic lymph nodes in the left side of the neck and has been treated with 145 mCi of radioiodine I 131. The examination after 5 months shows elevation of thyroglobulin, more than 20000 ng/ml and focally uptake of J 131 in the left lung. Patient was treated once again with 150 mCi radioiodine J 131. Whole body scintigraphy was registered focal uptake of radioiodine in the middle of the left collarbone. After a month, patient refers the enlargement of the lymph node in the right side of the neck. Currently patient is being treated with kinase inhibitor drug sorafenib and ibandronate. We have identified first positive response in treatment. Enlarged lymph node in the neck was reduced and the patient began feeling better.Conclusion:This study suggests that some subtypes of papillary thyroid carcinoma appear to have more aggressive biological course. Subtypes of papillary thyroid carcinoma such as diffuse sclerosing carcinoma, tall cell or columnar cell and insular variants, appears to have more aggressive biological course and need early detection and other kind of treatment.
a im: Renal agenesis is a fairly common congenital anomaly with an unknown definite etiology. Unilateral renal agenesis is much more common than bilateral renal agenesis, but it usually does not carry any major health consequence, as long as the other kidney is healthy. In some cases, renal agenesis may by associated with other congenital anomalies. We report a neonatal female patient born with unilateral renal agenesis associated with malrotation of ipsilateral kidney, anal atresia and pulmonary artery failure. Material and methods: One month old female child was referred to Nuclear Medicine Department for dynamic renal scintigraphy which performed after intravenously injection of 0.5 mCi 99m TcDTPA. Scintigraphy was carried out on a Dual Head-Siemens gamma camera using a high resolution collimator. During the dynamic scintigraphy patient was positioned in a supine position. Furosemide, as diuretic stimulator was administered intravenously at 18th minute of the study. Results: The female patient, eight months old, with cough, short breath (dispnea), fatigue, nausea, vomiting and diarrhea was referred to DTPA renal scintigraphy. Symptoms were manifested ten days before patient had undergone the renal scintigraphy. During this time the patient was under pediatrics' control. A patient has undergone the biochemistry, ultrasound and radiologic examinations. Samples were isolated from the urine culture Pseudomonas aureginosa. The patient received antibiotics (Amikacin) for seven days, whereas last five days she received salbutamole and bisolvon. During physical examination we noticed a left abdominal stoma without palpation sensibility associated with an imperforate anus. From DTPA renal scintigraphy we found the absence of a right kidney, malrotation of a left kidney associated with seriously problems during the elimination of urine. Discussion: Unilateral renal agenesis usually is without any major health consequences, but in cases where it is associated with other congenital malformations, such as malrotation of existing kidney, anal atresia and cardiopulmonary anomalies can be very serious problem for life. Conclusion: Dynamic renal scintigraphy is very highly sensitive and helpful method for detection of renal congenital malformations and function abnormalities.
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