Neuroendocrine metastasis to the thyroid from unknown primary and extrathyroidal disease response to peptide receptor radionuclide therapy

Authors

Tasnim Khessib, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care, 300 Pasteur Drive, Palo Alto, CA 94305, USA.
Samy Khessib, Department of Student Affairs, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA.
Gerald Berry, Division of Surgical Pathology, Department of Pathology, Stanford Health Care, 300 Pasteur Drive, Palo Alto, CA 94305, USA.
Mari Aparici, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford Health Care, 300 Pasteur Drive, Palo Alto, CA 94305, USA.

Author Type(s)

Student

DOI

10.1016/j.radcr.2023.07.044

Journal Title

Radiology Case Reports

First Page

3945

Last Page

3948

Document Type

Article

Publication Date

11-1-2023

Abstract

Neuroendocrine tumor (NET) metastasis to the thyroid is rare, and its presentation as the first manifestation of primary malignancy elsewhere is even more uncommon. We present a case of a 41-year-old female who underwent biopsy of enlarging thyroid nodules with findings suspicious for medullary thyroid cancer (MTC). Subsequent thyroidectomy demonstrated NET of unknown primary in the left lower lobe. Immediate workup with Ga-DOTATATE-PET/CT revealed abnormal somatostatin receptor (SR) expressing lesions in the liver, right cervical nodes, thoracic paravertebral soft tissue, precoccygeal soft tissue, and right acetabulum concerning for sites of neuroendocrine malignancy. Due to disease progression while on octreotide injections, a decision was made at the multidisciplinary NET board for the patient to receive peptide receptor radionuclide therapy (PRRT) which includes 4 cycles of Lu-DOTATATE (Lutathera). The patient had no side effects nor toxicities during the 8 months of PRRT and achieved a partial treatment response in the early post-treatment scan at 6 weeks. This case illustrates the importance of distinguishing NET metastasis to the thyroid from MTC to ensure appropriate workup and treatment as well as predict the response of neuroendocrine malignancies to PRRT based on the visualized overexpression of SR in the SR-PET scans, despite the organ of origin.

Recommended Citation

Khessib, T., Khessib, S., Berry, G., & Aparici, M. (2023). Neuroendocrine metastasis to the thyroid from unknown primary and extrathyroidal disease response to peptide receptor radionuclide therapy. Radiology Case Reports, 18 (11), 3945-3948. https://doi.org/10.1016/j.radcr.2023.07.044