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00019616-201009000-00010ReportThe EndocrinologistThe Endocrinologist© 2010 Lippincott Williams & Wilkins, Inc.20September 2010 p 228-229I-131 Uptake in an Endometriotic Ovarian Cyst in a Patient With Papillary Thyroid CarcinomaCase ReportSrivatsa, Sumathi MD; Halkar, Raghuveer K. MDFrom the Division of Endocrinology (SS) and Nuclear Medicine (RKH), Emory University School of Medicine, Atlanta, GA.Reprints: Sumathi Srivatsa, MD, Division of Endocrinology, Metabolism, and Lipids, Emory University, 1365 Clifton Rd., N.E, Atlanta, GA 30322. E-mail: [email protected]:To present a case of I-131 uptake in an endometriotic ovarian cyst in a patient with papillary thyroid carcinoma.Methods:Review of case history, radiology, and pathology reports.Results and Conclusion:I-131 uptake elsewhere in a high-risk thyroid cancer patient can be challenging for the diagnosis, and surgery was required to establish the diagnosis of benign endometriotic cyst.A 34-year-old woman had thyroidectomy for thyroid enlargement and was found to have papillary thyroid carcinoma, diffuse sclerosing variant, with background lymphocytic thyroiditis. She also had evidence of cervical lymph node metastasis, and underwent lymph node dissection. Her serum thyroglobulin antibodies were positive.Thyroid hormone was withdrawn and iodine therapy, 150 mCi, was performed. A post-treatment scan revealed a thyroid remnant as well as uptake in the left adnexal region (Fig. 1). Ultrasound examination of pelvis revealed a complex cyst in the left ovary with septation and vascularity that measured 3.2 × 2.3 × 4.5 cm (Fig. 2).JOURNAL/endst/04.03/00019616-201009000-00010/figure1-10/v/2021-02-17T201939Z/r/image-tiff Anterior and posterior views of post I-131 treatment scan showing uptake in the neck region and left adnexal region.JOURNAL/endst/04.03/00019616-201009000-00010/figure2-10/v/2021-02-17T201939Z/r/image-tiff Longitudinal and transverse views of pelvic ultrasound revealing a complex cyst in the left ovary.The patient elected to have surgical removal of the ovarian cyst. Pathologic examination showed the cyst to be an endometriotic cyst with no evidence of struma ovarii or metastatic papillary carcinoma.DISCUSSIONIt is known that struma ovarii can be detected with an I-131 scan.1 Although ovarian metastases from a primary thyroid carcinoma are rare, Logani et al reported a case of a cystic ovarian metastasis from a papillary thyroid carcinoma.2 A dermoid cyst devoid of thyroid tissue was shown to be the cause of false-positive uptake on I-131 scintigraphy in another case.3 Although the mechanism of uptake of I-131 is not clear, there is one other report of an ovarian endometriotic cyst with I-131 avidity.4This report highlights the fact that in a high-risk patient like ours, I-131 uptake outside of the thyroid “bed” can be challenging. Patients should be counseled about the possibility of false-positive uptake. However, the definitive diagnosis can be established after surgery, especially when serum thyroglobulin measurement is not accurate because of positive antithyroglobulin titer.REFERENCES1. Macdonald W, Armstrong J. Benign struma ovarii in a patient with invasive papillary thyroid cancer: detection with I-131 SPECT-CT. Clin Nucl Med. 2007;32:380–382.[Context Link][Full Text][CrossRef][Medline Link]2. Logani S, Baloch ZW, Snyder PJ, et al. Cystic ovarian metastasis from papillary thyroid carcinoma: a case report. Thyroid. 2001;11:1073–1075.[Context Link][CrossRef][Medline Link]3. Rudoni S, Toubeau M, Vaillant G, et al. Dermoid cyst of the ovary. False positive diagnosis in iodine 131 scintigraphy of differentiated thyroid cancers. Presse Med. 1998;27:1379–1381.[Context Link][Medline Link]4. Lungo M, Tenenbaum F, Chaumerliac P, et al. Ovarian endometriosis cyst with iodine 131 uptake: first case of false positive in the follow up for differentiated thyroid carcinoma. Ann Endocrinol (Paris). 2000;61:147–150.[Context Link][Medline Link]papillary thyroid carcinoma00019616-201009000-0001000003072_2007_32_380_macdonald_papillary_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e202_citationRF_FLOATING))|11065404||ovftdb|SL0000307220073238011065404citation_FROM_JRF_ID_d2184e202_citationRF_FLOATING[Full Text]00003072-200705000-0000900019616-201009000-0001000003072_2007_32_380_macdonald_papillary_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e202_citationRF_FLOATING))|11065213||ovftdb|SL0000307220073238011065213citation_FROM_JRF_ID_d2184e202_citationRF_FLOATING[CrossRef]10.1097%2F01.rlu.0000259642.36291.0d00019616-201009000-0001000003072_2007_32_380_macdonald_papillary_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e202_citationRF_FLOATING))|11065405||ovftdb|SL0000307220073238011065405citation_FROM_JRF_ID_d2184e202_citationRF_FLOATING[Medline Link]1745286800019616-201009000-0001000008379_2001_11_1073_logani_metastasis_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e232_citationRF_FLOATING))|11065213||ovftdb|SL00008379200111107311065213citation_FROM_JRF_ID_d2184e232_citationRF_FLOATING[CrossRef]10.1089%2F10507250175327178900019616-201009000-0001000008379_2001_11_1073_logani_metastasis_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e232_citationRF_FLOATING))|11065405||ovftdb|SL00008379200111107311065405citation_FROM_JRF_ID_d2184e232_citationRF_FLOATING[Medline Link]1176271800019616-201009000-0001000006642_1998_27_1379_rudoni_differentiated_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e269_citationRF_FLOATING))|11065405||ovftdb|SL00006642199827137911065405citation_FROM_JRF_ID_d2184e269_citationRF_FLOATING[Medline Link]979305300019616-201009000-0001000000588_2000_61_147_lungo_differentiated_|00019616-201009000-00010#xpointer(id(citation_FROM_JRF_ID_d2184e306_citationRF_FLOATING))|11065405||ovftdb|SL0000058820006114711065405citation_FROM_JRF_ID_d2184e306_citationRF_FLOATING[Medline Link]10891665 Anterior and posterior views of post I-131 treatment scan showing uptake in the neck region and left adnexal region. Longitudinal and transverse views of pelvic ultrasound revealing a complex cyst in the left ovary.I-131 Uptake in an Endometriotic Ovarian Cyst in a Patient With Papillary Thyroid CarcinomaSrivatsa Sumathi MD; Halkar, Raghuveer K. MDCase ReportCase Report520p 228-229