Overall, the rhTSH primed (131)I therapy protocol was found to be feasible and a good alternative to the thyroid hormone withdrawal protocol in patients with metastatic DTC. The lesional dosimetry findings need to be further examined in subsequent studies. The rhTSH primed pretreatment scan at 24 h after diagnostic dose is suboptimal to determine whether a metastatic lesion concentrates (131)I and the posttreatment scan is important for the correct impression.
Malignant tumors of the breast have an inherent potential to metastasize more often to the regional lymph nodes. It is rare to find a metastasis to the oral region from a primary in the breast, but when this does occur, it usually involves the jawbones rather than the soft tissues. A 33-year-old premenopausal woman, a diagnosed case of locally advanced right breast carcinoma, underwent right modified radical mastectomy followed by chemotherapy as per the institutional protocol. She presented after 2 years with an exophytic growth in the upper alveolar region of the oral cavity. Biopsy indicated gingival metastasis from a poorly differentiated adenocarcinoma of the breast. She was referred for F-18 FDG PET scan to evaluate the disease status before planning radiotherapy to the gingival metastasis. F-18 FDG PET scan was done after intravenous injection of 370 MBq (10 mCi) of tracer. Whole-body PET images were reconstructed in iterative algorithm (OSEM). Whole-body F-18 FDG PET scan showed hypermetabolic foci in the midmaxillary region (SUV max: 6.5), upper end of the right humerus, a large hypermetabolic area in the upper zone of the right lung with contiguous hilar node involvement on the right side of the lung, and an area of intense hypermetabolic activity in the left acetabular and ischial region. The present case demonstrates a rare site of metastasis in the oral region from carcinoma of the breast.
A bone scan done for a 58-year-old man with intense pain in the lower back and pelvis, showed intense MDP uptake in most of the pelvis, in the proximal aspect of the left femur, D-8 vertebra, and a focal area of uptake in the skull. The features were suggestive of Paget's disease. An x-ray of pelvis revealed multiple sclerotic lesions in the pelvis (left ischium, acetabulum, and supra-acetabular regions of left ilium, right acetabulum, the left femoral neck, and left hip joint), suggesting metastases. On clinical examination, he had a left hydrocele. Peroperatively, a mass was found in the left testis for which a left orchidectomy was done. The histopathology was high-grade malignant germ cell tumor. Fine needle aspiration cytology from the pelvis confirmed the presence of metastases from germ cell tumor.
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