case_images: PMC3965951_01
case_images: Whole-body scan with a diagnostic dose of 185 MBq I-131 showing no pathologic uptake in the body, anterior-posterior incidences.
case_images: CRIE2014-741262.001.jpg
case_images: PMC3965951_01_CRIE2014-741262.001.jpg
case_images: fig1
case_images: The patient was followed up all the time in the same department, according to the procedure applied for differentiated thyroid carcinoma: clinical exam, thyroid and neck ultrasound, and either by thyroid hormone withholding or by 2 I.M. injections of recombinant TSH (rTSH) he was checked for the specific thyroid tumor markers: TSH > 40 mIU/L, the serum value of Tg < 0.1 ng/mL (N.V. < 0.1 ng/mL), and anti-Tg < 10 kIU/L (N.V. < 141 kIU/L). The WBS I-131 under a diagnosis dose of 185 MBq of I-131 was negative (Figure 1).
case_images: The computer tomography scan of the upper mediastinum presenting the recurrence of the tumor.
case_images: CRIE2014-741262.002.jpg
case_images: PMC3965951_01_CRIE2014-741262.002.jpg
case_images: fig2
case_images: The CT showed in the upper mediastinum in close contact with the vessels, compressing the trachea, a tumor highly vascularized of 2.5/3 cm (Figure 2).
case_images: Immunohistochemical examination revealed medullary thyroid carcinoma calcitonin 200x.
case_images: CRIE2014-741262.003.jpg
case_images: PMC3965951_01_CRIE2014-741262.003.jpg
case_images: fig3
case_images: The patient was referred to F-18 FDG positron emission computer tomography PET-CT exam that showed glucose avidity of the tumor with a standard uptake value lean body mass SUVlbm of 6.2 (cut-off value for malignant tissues 2.5). The patient was operated on, but, due to the invasiveness of the mass in the vessels, the surgeon removed only partially the tumor and the histology revealed medullary thyroid carcinoma (MTC) (Figure 3).
case_images: F18-FDG-PET-CT after the therapy in June 2013, showing the persistency of the tumor in the upper mediastinum with high glucose uptake and SUVlbm 3.67.
case_images: CRIE2014-741262.004.jpg
case_images: PMC3965951_01_CRIE2014-741262.004.jpg
case_images: fig4
case_images: The scan showed the persistency of the pathologic uptake in the upper mediastinum, but with a lower SUVlbm-3.67 and no other metastatic lesions (Figure 4).
case_images: The serum levels of the calcitonin during the follow-up period January 2012-June 2013 (pg/mL).
case_images: CRIE2014-741262.005.jpg
case_images: PMC3965951_01_CRIE2014-741262.005.jpg
case_images: fig5
case_images: The calcitonin values during the follow-up period January 2012-June 2013 are shown in Figure 5.