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FDG PET scans can reveal incidental thyroid nodules, with about a third being malignant. This case highlights Hürthle cell neoplasms as a cause of intensely FDG-avid thyroid nodules.

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Area of Science:

  • Nuclear Medicine
  • Oncology
  • Endocrinology

Background:

  • Fluorodeoxyglucose Positron Emission Tomography (FDG PET) is utilized for staging and monitoring nonthyroidal malignancies.
  • Incidental thyroid uptake on FDG PET occurs in ~2.5% of patients, with a significant proportion representing malignancy.

Observation:

  • A 50-year-old woman, evaluated for heart transplantation and with a history of breast cancer, presented with a large, intensely FDG-avid thyroid mass on PET/CT.
  • Histopathological and molecular analysis confirmed the thyroid mass to be a Hürthle cell adenoma.

Findings:

  • Hürthle cell neoplasms can exhibit very high FDG avidity, mimicking malignant thyroid lesions on PET imaging.
  • This finding expands the differential diagnosis for hypermetabolic thyroid nodules detected incidentally.

Implications:

  • Clinicians should consider Hürthle cell neoplasms in the differential diagnosis of intensely FDG-avid thyroid incidentalomas.
  • This case underscores the importance of careful evaluation of thyroid incidentalomas, regardless of patient history.
  • Further research may elucidate specific imaging characteristics or molecular markers to differentiate benign from malignant Hürthle cell neoplasms.