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Localization of Medullary Thyroid Carcinoma Metastasis in a Multiple Endocrine Neoplasia Type 2A Patient by 6-[¹⁸F]-Fluorodopamine Positron Emission Tomography

Clinical Endocrinology Branch (L.G., N.J.S.), National Institute of Diabetes, Digestive, and Kidney Diseases; Nuclear Medicine Department (J.C.R.), Warren G. Magnuson Clinical Center; Office of the Clinical Director, National Institute of Communicative Disorders and Deafness (C.V.); Laboratory of Pathology (M.J.M.), National Cancer Institute; and Pediatric and Reproductive Endocrinology Branch (K.P.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Karel Pacak, M.D., Ph.D., D.Sc., Pediatric and Reproductive Endocrinology Branch/National Institute of Child Health and Human Development, National Institutes of Health, Building 10, Room 9D42, 10 Center Drive, Bethesda, Maryland 20892-1583. E-mail: karel{at}mail nih.gov.

6-[¹⁸F]fluorodopamine, a substrate for the norepinephrine transporter, has been used as a tumor-seeking tracer in positron emission tomography (PET) to localize pheochromocytomas and other chromaffin tumors. Here, we report the case of a 42-yr-old woman with multiple endocrine neoplasia type 2A, in whom biopsy-proven recurrent medullary thyroid cancer (MTC) was detected by 6-[¹⁸F]fluorodopamine PET scanning. The patient had previously undergone bilateral adrenalectomy for pheochromocytoma, total thyroidectomy, and extirpation of a parapharyngeal MTC metastatic deposit. An increase in plasma calcitonin 5 yr after her initial presentation was further investigated, leading to the discovery of a mass in the left parapharyngeal space. Levels of serum and urine catecholamines and metanephrines were normal. To exclude a hormonally silent pheochromocytoma metastasis, 6-[¹⁸F]fluorodopamine PET was performed. The study showed a focus of radionuclide accumulation corresponding to the parapharyngeal mass. After resection of the latter, pathology confirmed metastatic MTC. To our knowledge, this is the first case of metastatic, histologically proven MTC, which was unequivocally detected by 6-[¹⁸F]fluorodopamine PET scanning. Because norepinephrine transporter systems have been previously found in MTC, it is conceivable that 6-[¹⁸F]fluorodopamine PET scanning can be used for the diagnostic localization of this tumor and its metastatic deposits because total and early resection is beneficial to the outcome of the patient.

This work was presented in part at the 84th Annual Meeting of The Endocrine Society, San Francisco, California, June 2002.

L.G. and N.J.S. contributed equally to this work.

Abbreviations: CEA, Carcinoembryonic antigen; CT, computed tomography; DTPA, ¹¹¹In-diethylenetriamine-pentacetic acid; MEN, multiple endocrine neoplasia; MIBG, ¹²³I-meta-iodobenzylguanidine; MRI, magnetic resonance imaging; MTC, medullary thyroid cancer; NR, normal range; PET, positron emission tomography; U/S, ultrasonography.

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