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All Journal Majalah Patologi Indonesia Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Bethy Suryawathy Hernowo
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Clinicopathological Characteristic of Radioactive Iodine-Refractory Differentiated Thyroid Carcinoma at Dr. Hasan Sadikin Hospital 2016-2021 Tutik Nur Ayni; Hasrayati Agustina; Bethy Suryawathy Hernowo; Raden Erwin Affandi Soeriadi Koesoemah; Yohana Azhar
Majalah Patologi Indonesia Vol. 33 No. 1 (2024): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Anatomik Indonesia (PDSPA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55816/mpi.v33i1.606

Abstract

Background Initial therapy for differentiated thyroid carcinoma (DTC) is thyroidectomy with or without cervical lymph node dissection. Furthermore, radioactive iodine (RAI) is given to patients by considering risk stratification and other patient factors. Although most cases of DTC have a good prognosis after standard therapeutic approaches, the risks of local recurrence and distant metastases can be as high as 20% and 10%. Among these patients, two-thirds showed RAI-refractory. This is concerning because 10-year survival rate is less than 10%. This study aimed to analyze the clinicopathological characteristics of RAI-refractory DTC.   Methods This is a case-control study. Data was collected from the Department of Nuclear Medicine and Molecular Theranostics and Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung period 1 January 2016-31 December 2021.   Results Clinicopathological factors associated with RAI-refractory DTC are age, sex, aggressive histologic subtype, LVI (lymphovascular invasion), m-ETE (microscopic extrathyroid extension), TNM (tumor, nodal, metastasis) stage, and ENE (extranodal extension), with p-value <0.05. Meanwhile, there was no significant difference in the histologic type between RAI-refractory and non-RAI-refractory groups.   Conclusion In the pathology report, it is necessary to include prognostically relevant tumor histopathological characteristics. In addition to histologic type, histologic subtype, and tumor size, other features such as presence and extent of capsular invasion, LVI, microscopic and macroscopic ETE, ENE, and number and size of metastatic lymph nodes, have been shown to provide additional prognostic information and are required in standard pathology reports for DTC.
Unmasking the Primary: The Role of 99mTc-Sestamibi SPECT/CT in a Case of Carcinoma of Unknown Primary with Suspected Lung Origin Jessica Ubercaprita; Endah Indriani Wahyono; Mas Adi Sunardi; Herry Herman; Bethy Suryawathy Hernowo; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1361

Abstract

Background: Carcinoma of unknown primary (CUP) is a challenging clinical diagnosis, representing histologically confirmed metastatic cancer where the primary tumor site remains unidentified after a standard diagnostic workup. While 18F-FDG PET/CT is recommended by current guidelines, its accessibility is limited in many regions. This report explores the diagnostic utility of Technetium-99m (99mTc)-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) as a valuable alternative. Case presentation: A 67-year-old female presented with musculoskeletal pain. A biopsy of a right ulnar lesion confirmed metastatic carcinoma. Immunohistochemistry (IHC) suggested a possible primary from the lung, breast, or upper gastrointestinal tract. Due to the unavailability of 18F-FDG PET/CT, a 99mTc-Sestamibi whole-body scan with SPECT/CT was performed. The scan identified a metabolically active, malignant-appearing nodule in segment 6 of the left lung and confirmed widespread skeletal metastases. Although a lung biopsy was not feasible due to limited access, the patient was treated with a lung cancer protocol. This resulted in significant clinical improvement. Conclusion: 99mTc-Sestamibi SPECT/CT served as a critical diagnostic tool in this case of CUP. It successfully identified a suspected pulmonary primary, enabling targeted therapy and leading to a positive clinical outcome. This case highlights the modality's efficacy as a tumor-seeking agent and underscores its essential role in the diagnostic armamentarium for CUP, particularly in resource-limited healthcare settings.
Unmasking the Primary: The Role of 99mTc-Sestamibi SPECT/CT in a Case of Carcinoma of Unknown Primary with Suspected Lung Origin Jessica Ubercaprita; Endah Indriani Wahyono; Mas Adi Sunardi; Herry Herman; Bethy Suryawathy Hernowo; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1361

Abstract

Background: Carcinoma of unknown primary (CUP) is a challenging clinical diagnosis, representing histologically confirmed metastatic cancer where the primary tumor site remains unidentified after a standard diagnostic workup. While 18F-FDG PET/CT is recommended by current guidelines, its accessibility is limited in many regions. This report explores the diagnostic utility of Technetium-99m (99mTc)-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) as a valuable alternative. Case presentation: A 67-year-old female presented with musculoskeletal pain. A biopsy of a right ulnar lesion confirmed metastatic carcinoma. Immunohistochemistry (IHC) suggested a possible primary from the lung, breast, or upper gastrointestinal tract. Due to the unavailability of 18F-FDG PET/CT, a 99mTc-Sestamibi whole-body scan with SPECT/CT was performed. The scan identified a metabolically active, malignant-appearing nodule in segment 6 of the left lung and confirmed widespread skeletal metastases. Although a lung biopsy was not feasible due to limited access, the patient was treated with a lung cancer protocol. This resulted in significant clinical improvement. Conclusion: 99mTc-Sestamibi SPECT/CT served as a critical diagnostic tool in this case of CUP. It successfully identified a suspected pulmonary primary, enabling targeted therapy and leading to a positive clinical outcome. This case highlights the modality's efficacy as a tumor-seeking agent and underscores its essential role in the diagnostic armamentarium for CUP, particularly in resource-limited healthcare settings.
Co-Authors Basuki Hidayat Endah Indriani Wahyono Hasrayati Agustina Herry Herman Jessica Ubercaprita Mas Adi Sunardi Raden Erwin Affandi Soeriadi Koesoemah Tutik Nur Ayni Yohana Azhar