18F-FDG PET of Patients with Hürthle Cell Carcinoma

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FIGURE 1.
PET image of patient 2, who had history of Hürthle cell cancer and returned with complaint of diffuse aches. Single indeterminate lung nodule with some mediastinal adenopathy was seen on CT. Sonography and ¹³¹I scans had negative findings. PET image showed widespread bone and lung metastases, which were confirmed with right hilar biopsy.
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FIGURE 2.
PET image of patient 8, who had Hürthle cell cancer previously treated and who returned with elevated thyroglobulin level (800 ng/mL) for evaluation. Neck sonography and ¹³¹I scan had negative findings. PET image showed lung, vertebral body, and pelvis/femur (arrow) metastases. Biopsy of pelvis confirmed metastatic disease.
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FIGURE 3.
PET image of patient 9, who had Hürthle cell cancer previously treated and who returned for follow-up evaluation. Neck sonography showed 1-cm right-neck lymph node suggestive of Hürthle cell cancer. PET image showed variable nonspecific uptake in neck and chest, and no definite tumor was believed to be present. Biopsy 2 mo later of region seen on sonography confirmed disease (2/4 grade Hürthle cell cancer), which was also likely near right-lower-neck uptake seen on PET (arrow).

TABLE 1

Patient Data

Patient no.	Sex	Findings
				PET			CT			Neck sonography	¹³¹I/¹²³I	Pathology
				Local	Distant	Local	Distant			Neck sonography	¹³¹I/¹²³I	Pathology
1	M	Neg	Pos	NA	Indeterminate	Neg	ND	Pos	Indeterminate lung nodule shown to be positive on PET
2	M	Neg	Pos	NA	Pos	Neg	Neg	Pos	Much more extensive distant disease on PET
3a	F	Neg	Pos	NA	Pos	Neg	Neg	Pos	Confirmed disease
3b	F	Pos	Neg	NA	Neg	Pos	ND	ND (F/U pos)	Confirmed disease
4	M	Neg	Pos	NA	Pos	Pos	Neg	ND (F/U pos)	Confirmed disease
5	F	Neg	Pos	NA	Pos	Neg	ND	ND (F/U pos)	Confirmed disease
6	M	Neg	Pos	NA	Pos	Neg	ND	Pos	Confirmed disease
7	F	Neg	Neg	NA	Neg	Neg	Indeterminate	Neg	Confirmed disease
8	M	Neg	Pos	ND	ND	Neg	Neg	Pos	Showed unknown distant disease (pelvis)
9	F	Neg	Neg	Neg	Neg	Pos	ND	Pos	PET falsely read as negative
10	F	Pos	Pos	Neg	Neg	NA	ND	Pos	Showed unknown distant disease (mediastinum)
11	M	Pos	Pos	Pos	Neg	Neg	ND	Neg (pleural fluid)	Suspected metastatic disease from PET: treated
12a	M	Pos	Pos	Pos	Indeterminate	Pos	Neg	Pos	Indeterminate lung nodules shown to be positive on PET
12b	M	Pos	Neg	Neg	Indeterminate	Indeterminate	Neg	Pos	Active local disease seen on PET only

Neg = negative result; Pos = positive result; ND = not done; F/U pos = follow-up considered active disease to be present.