Nuclear Medicine and Molecular Imaging

, Volume 52, Issue 5, pp 394–397 | Cite as

Langerhans’ Cell Histiocytosis Masquerading as Metastatic Papillary Thyroid Cancer on F-18 FDG PET/CT: Diagnostic Dilemma Solved by PET/CT-Guided Biopsy

  • Dharmender Malik
  • Rajender KumarEmail author
  • Bhagwant Rai Mittal
  • Gaurav Parkash
  • Amanjit Bal
  • Anish Bhattacharya
Interesting Image


We present a case of papillary thyroid cancer (post-thyroidectomy status) on regular treatment with suppressive Levothyroxine therapy. On follow-up at 6 months after radioactive iodine ablation for remnant thyroid tissue, her thyroglobulin, and anti-thyroglobulin levels were 0.06 ng/ml and 670 IU/ml, respectively. Low-dose whole-body I-131 scan was negative. To look for the cause of isolated increased anti-thyroglobulin level, a whole-body 18F-FDG PET/CT was done which revealed multiple FDG-avid lytic skeletal lesions suggestive of metastases. For confirmation of diagnosis, 18F-FDG PET/CT-guided metabolic biopsy was done, which revealed Langerhans’ cell histiocytosis on histopathological examination.


Papillary thyroid cancer Langerhans’ cell histiocytosis Anti-thyroglobulin level 18F-FDG PET/CT PET/CT-guided biopsy 


Compliance with Ethical Standards

Conflict of Interest

Dharmender Malik, Rajender Kumar Basher, Bhagwant Rai Mittal, Gaurav Parkash, Amanjit Bal, and Anish Bhattacharya declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.


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Copyright information

© Korean Society of Nuclear Medicine 2018

Authors and Affiliations

  • Dharmender Malik
    • 1
  • Rajender Kumar
    • 1
    Email author
  • Bhagwant Rai Mittal
    • 1
  • Gaurav Parkash
    • 2
  • Amanjit Bal
    • 3
  • Anish Bhattacharya
    • 1
  1. 1.Department of Nuclear MedicinePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of Internal MedicinePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  3. 3.Department of PathologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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