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Disseminated Bone Marrow Metastases of Insular Thyroid Carcinoma Detected by Radioiodine Whole-Body Scintigraphy

Departments of Nuclear Medicine, Radiology, Human Pathology and Histology, Sacred Heart Catholic University, Rome, Italy
Division of Nuclear Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan

Correspondence: For correspondence or reprints contact: Vittoria Rufini, MD, Institute of Nuclear Medicine, Sacred Heart Catholic University, Policlinico A. Gemelli, Largo A. Gemelli, 8 Rome 00168, Italy.

ABSTRACT

We present ¹³¹I scintigraphic findings in a patient with insular carcinoma of the thyroid showing diffuse abnormal uptake throughout the skeleton. The scintigraph closely resembled the pattern of [¹³¹I]MIBG distribution in children with bone marrow metastases of neuroblastoma. The extent of involvement was underestimated by bone scintigraphy and radiography. Insular carcinoma of the thyroid in the bone marrow was subsequently demonstrated by biopsy. The patient was treated with 242 mCi ¹³¹I given in two courses, which led to severe myelosuppression and died as a result of progressive disease and severe pancytopenia 10 mo after initial therapy.

Key Words: insular thyroid carcinoma • bone marrow metastases • iodine-131