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Liver Cavernous Hemangioma Mimicking Metastatic Thyroid Carcinoma
from: Shu-Hua Huang1, Ya-Hui Hu2, Yu-Erh Huang1, Hue-Yong Chen1, Yu-Fan Cheng 3, Chiang- Hsuan Lee1, Pei-Wen Wang1, 2 1. Department of Nuclear Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan 2. Department of Endocrinology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan 3. Department of Radiology, Chang Gung Memorial Hospital, Kaohsiung, TaiwanWhole body scan may detect the functioning metas- tasis of differentiated thyroid carcinoma. However non- thyroidal false positive uptake may mislead the physi- cian to inappropriate treatment. We report a case of 45- year-old woman with papillary thyroid carcinoma who demonstrated strong 131I uptake in a cavernous heman- gioma of the liver. This common benign liver lesion is usually incidentally discovered in patients without clini- cal evidence of liver disease and most frequently occurs in woman between the third and fifth decade of life. Combination of ultrasound, contrast-enhanced CT and 99mTc labeled RBC scanning using SPECT may help to make a good differential diagnosis. We report this case to raise index of suspicion of this common benign disease to avoid unnecessary radiotherapy.
I whole-body imaging has been widely used as the tool for detecting functional metastasis of differentiated thy- roid carcinoma. However, nonthyroidal uptake of 131I may interfere with interpretation of the image. Such false-positive uptake is rare but it may result in inappropriate treatment. Cavernous hemangioma of the liver, a common benign liver lesion, is usually incidentally discovered in patients without clinical evidence of liver disease. We report a case of liver hemangioma trapping 131I, which has not been reported before.
Case Report
The patient was a 45-year-old woman, who had a 3 cm- sized neck mass for 3 years. She underwent near-total thy- roidectomy in October 1993 after the diagnosis of papillary thyroid carcinoma. A 5 mCi is diagnostic whole-body image at 6 weeks after surgery revealed neck remnant and a focal area of increased uptake in the right upper abdominal region. At that time, her serum TSH and thyroglobulin levels after L- thyroxine withdrawal for 6 weeks were 50 µ IU/ml and 106ng/ml respectively. Liver metastatic was considered. A dose of 150 mCi 131I was given 1 week later to ablate the liver “metastatic lesion” and the post-ablative whole-body scan confirmed the findings of the preceding 5 mCi diagnostic image (Figure 1). Simultaneous liver sulfur colloid image confirmed that the area of 131I accumulation in whole body scan was a cold lesion in the posterior superior aspect of the liver. Abdominal CT and sonography were performed and showed a 4 cm-sized mass in the segment 7 of the right lobe with marked contrast medium enhancement.
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