Von Meyenburg Complex (biliary hamartoma) mimicking liver metastasis of papillary thyroid carcinoma on post-treatment total-body 131-iodine scintigraphy

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 459-496-Thyroid Neoplasia & Case Reports
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-476
Pieter T. E. Postema*1, Gül Eker1, Judocus J.J. Borm1, Nomdo Renken2, Peter W. de Graaf3, Max C. W. Jebbink4, Marian Tervoort3, Dave Henri Schweitzer5 and Wouter W. de Herder6
1Reinier de Graaf Gasthuis, Delft, Netherlands, 2Reinier de Graaf Gasthuis, 2625AD, Netherlands, 3Reinier de Graaf Gasthuis, Delft, 4Reinier de Graaf Hosp, Delft, Netherlands, 5Reinier De Graaf Groep Delft, Delft, Netherlands, 6Erasmus MC, Rotterdam, Netherlands
A 52 year old woman presented with locoregional recurrence of papillary thyroid cancer. She was diagnosed 30 years before with T2N1M0 papillary thyroid carcinoma and initially treated with total thyroidectomy and 75 mCi 131-radioiodine. During follow-up no recurrence was observed, however recently a 0,8 cm paratracheal lesion was found on routine ultrasonography. Thyroglobulin level on thyroxine suppletion was 0,2 ug/l and 8,6 ug/l after withdrawal of thyroxine. Fine-needle-aspiration confirmed recurrence of papillary thyroid carcinoma and she received treatment with 200 mCi 131-radioiodine. Post-treatment total-body scintigraphy after 7 days showed diffuse uptake in the liver, especially at the sub-diaphragmatic region. MRI of the liver showed diffuse, small lesions, hypo-intense on T1 and hyper-intense on T2 and without attenuation after gadolineum, concordant with the MRI-imaging.  A liver biopsy was performed which revealed multiple biliary hamartoma (Von Meyenburg Complex) and no metastasis of papillary thyroid carcinoma. Thyroid hormone is secernated in glucuronated and sulfated forms into bile and re-uptake takes place in the intestines after degradation by the intestinal microflora, thus establishing an enterohepatic circulation (1). False-postive radioiodine liver-uptake has been reported in biliary obstruction with or without stones (2). We propose that radioiodinated thyroid hormone is either accumulated in the biliary hamartoma itself or in obstructed bile ducts and therefore gives a false-positive result in the Von Meyenburg Complex mimicking metastastes of thyroid carcinoma.

(1) De Herder WW et al., Life Sci. 1989;45(9):849-56. (2) Oh JR et al., Am J Nucl Med Mol Imaging. 2012; 2(3): 362–385.

Nothing to Disclose: PTEP, GE, JJJB, NR, PWD, MCWJ, MT, DHS, WWD

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