PMC7378381_01
(A) 68Ga-DOTATOC PET-CT (upper panel) and (B) 18F-FDG PET-CT (lower panel). (A) 68Ga-DOTATOC PET-CT showed accumulation of radiotracer in left epiglottic region; (B) 18F-FDG PET-CT showed uptake of the radiotracer in the left emilarynx lesion, SUV max 9.3, and in two laterocervical lymph nodes, SUV max 11.4 and 7.
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F1
A 68Ga-DOTATOC PET-CT showed accumulation of radiotracer in the left epiglottic region (Figure 1A). After 9 months of treatment, an 18F-FDG PET-CT (Figure 1B) showed increased dimensions (22 vs. 19 mm) and uptake of the radiotracer (SUV max, 9.3 vs. 6) in the left emilarynx lesion.
Thyroid and neck ultrasound. An irregular hypoechoic nodule (11 x 7 mm) with (A,B) calcifications in the paraisthmic portion of the left thyroid lobe and (C,E,F) multiple suspected lateral cervical rounded, hypoechoic, and inhomogeneous lymphadenopathies without ilum, showing an panel (D) unorganized peripheral and central vascularization.
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F2
A thyroid color Doppler ultrasound was performed, and it showed an irregular hypoechoic nodule (11 x 7 mm) with calcifications in the paraisthmic portion of the left thyroid lobe and also confirmed the presence of multiple lateral cervical lymphadenopathies (Figure 2).
Metastasis of neuroendocrine tumor. The neoplasia infiltrating the connective tissue show a solid and only focal tubuloacinar arrangement of cells with moderate nuclear atypia. There is not any necrosis. (H&E, x 10). The immunohistochemical stains (x 10) show positivity of tumor cells for epithelial (CKAE1/AE3) and neuroendocrine markers (ChrA, Syn, and CD56) and a proliferative index Ki67 of 5%. The tumor cells are also positive for calcitonin and TTF-1. H&E, hematoxylin and eosin; CKAE1/AE3, pan cytokeratins AE1/AE3; ChrA, chromogranin A; Syn, synaptophysin; CD56, NCAM; TTF-1, thyroid transcription factor 1.
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F3
The histological examination revealed benign hyperplastic nodules in the thyroid gland, two of the five resected lymph nodes and cutaneous fragments as metastasis of a neuroendocrine tumor G2, positive for calcitonin, as shown in Figure 3.