On February 11, Sina Jasim, MD, MPH and co-authors had their case report titled “Suture Granuloma and Surgical Clips as a Mimic of Thyroid Cancer Recurrence,” published in “AACE Clinal Case Reports.”
The case presentation describes a 59-year-old White male with multifocal papillary thyroid cancer, a status post of total thyroidectomy and radioactive iodine treatment. Although there had been no evidence of recurrence within the patient for 6 years, he had a 3-month palpable neck mass. While physical examination showed bilateral palpable neck nodules, lab tests showed normal thyroid-stimulating hormone and a thyroglobulin level that was undetectable. The patient’s neck ultrasound and CT presented concern for thyroid cancer recurrence due to the bilateral neck masses. Following this, a fine needle aspiration biopsy confirmed recurrent thyroid cancer.
The diagnosis was challenging because the thyroglobulin level was undetectable, the iodine scan was unremarkable, and the pathology findings were reassuring. “Those results were discordant with the avidity seen on PET/CT that favored malignancy, highlighting the role of neck ultrasound to complement the workup.”
After the case presentation, it was reviewed by “a multidisciplinary group that agreed the presentation was consistent with inflammatory response and suture granulomas related to the previous thyroidectomy.” The case “demonstrates that suture granulomas and surgical clips from prior surgery can imitate recurrent malignancy on thyroid ultrasound and 18F-fluorodeoxyglucose PET/CT.”
Ultra-sonographers, radiologists, and clinicians should familiarize themselves with sonographic cancer mimics — chronic granulomatous lesion, traumatic neuroma, reactive lymph node, and cervical thymus. Additionally, extra precautions should be taken during PET scan interpretations because a known 18F-fluorodeoxyglucose-avid is inflammation in the head and neck.