Calcified liver metastases from medullary thyroid carcinoma in a Multiple Endocrine Neoplasia Type 2A patient

Calcified liver lesions encompass a broad differential diagnosis, with calcified hepatic granulomas being the most frequently encountered. We report a rare case of calcified hepatic metastases that were initially misinterpreted as hepatic granulomas. A 51-year-old patient with known Multiple Endocrine Neoplasia Type 2A had a history of medullary thyroid carcinoma treated surgically with total thyroidectomy and bilateral neck dissection in 2005. Serial CT scans obtained between 2010 to 2025 showed a few progressively enlarging calcified hepatic lesions that were initially misinterpreted as calcified hepatic granulomas. Due to persistently elevated tumor markers, a 18F-DOPA PET/CT was performed, which demonstrated increased radiotracer uptake of these lesions, suggesting they are metabolically active hepatic metastasis. MRI with Gadoxetate disodium also showed finding suggestive of hypervascular hepatic metastases. Diagnostic laparoscopy and histopathology confirmed the diagnosis of calcified hepatic metastasis from medullary thyroid carcinoma. This case emphasizes that hepatic calcifications, though often presumed benign, may occasionally represent other underlying pathologies such as metastatic disease. We hope to describe the imaging features of calcified hepatic metastases from medullary thyroid carcinoma, and the differentials of calcified hepatic lesions.