Osteosarcoma of the Clavicle and Scapula Secondary To the Radiotheraphy for Servical Metastases of the Differentiated Thyroid Cancer: Case Report

Abstract

he role of radiotheraphy (RT) for the differentiated thyroid cancer (DTC) still remains controversial although it has been used in patients with DTC in case of postoperative residual disease, local recurrence, or when cancer is refractory to radioiodine treatment. [1][2][3][4][5][6] Approximately 5 % of sarcomas develop after therapeutic or accidental irradiation.7 In osteosarcomas, three-phase bone scintigraphy is often used to evaluate the primary lesion and to search for bone metastases. In this paper, we present a radiation induced osteosarcoma of the clavicle and scapula in a DTC patient in whom three-phase bone scan and I-131 radioiodine scan are used for diagnosis. CASE REPORTA 67-year-old woman previously diagnosed as DTC was transferred to our clinic with swelling, pain, and stiffness of left supraclavicular region and Turkiye Klinikleri J Med Sci 2010;30 (1) 413 Osteosarcoma of the Clavicle and Scapula Secondary To the Radiotheraphy for Servical Metastases of the Differentiated Thyroid Cancer: Case Report A AB BS S T TR RA AC CT T A 67-ye ar-old wo man pre vi o usly di ag no sed with dif fe ren ti a ted thyro id can cer (DTC) was trans fer red to our cli nic with comp la ints of swel ling, pa in, stiff ness of the left sup rac la vi cu lary re gi on and left sho ul der. She had un der go ne ra di ot he raphy for DTC ser vi cal lymph no de me tas tases fo ur te en ye ars ago. Di ag nos tic I-131 who le body scan sho wed in cre a sed up ta ke in thyro id re gion wit ho ut any up ta ke com pa tib le with me tas ta ses. Thre e pha se bo ne scan sho wed in ten se up ta ke wit hin the ex pan si ve mass in the re gi on of the left cla vic le and left sho ul der in all thre e pha ses. Histo pat ho lo gi cal revealed os te o sar co ma of the left cla vic le. Os te o sar co ma of the cla vic le and sca pu la fol lo wing ra di ot he rapy for DTC is ra re con di ti on. Di ag nos tic I-131 who le body scan and thre e phase bo ne scan are use ful for di ag no sis of ra di a ti on in du ced os te o sar co ma in DTC pa ti ents.K Ke ey y W Wo or rd ds s: : Thyroid neoplasms; osteosarcoma; radiotherapy Ö ÖZ ZE ET T Diferansiye tiroid kanseri tanılı 67 yaşındaki bayan hasta sol supraklaviküler bölgede ve omuzda şişlik, ağrı ve hareket kısıtlılığı şikayetleri ile kliniğimize başvurdu. Hastaya 14 yıl önce DTC servikal lenf nodu metastazı nedeniyle radyoterapi uygulanmış idi. I-131 tüm vücut sintigrafisinde tiroid lojunda artmış tutulum izlendi. Üç fazlı kemik sintigrafisinde sol klavikula ve omuzda yoğun aktivite tutulumu izlendi. Sol klavikuladan yapılan histopatolojik analizde osteosarkom saptandı. DTK hastalarında radyoterapiye sekonder osteosarkom gelişimi nadir bir durumdur. I-131 tüm vücut tarama sintigrafisi ve üç fazlı kemik sintigrafisi DTK hastalarında radyoterapiye bağlı gelişen osteosarkom tanısında faydalı metodlardır.