Carcinoembryonic Antigen Increase in a Patient with Colon Cancer Who Have Achieved Complete Remission and Negative ¹⁸F-FDG PET/CT: Don’t Forget the Thyroid!

• Main Authors: Alexandre Lugat, Pauline Hulo, Catherine Ansquer, Yann Touchefeu, Eric Mirallié, Jaafar Bennouna, Delphine Drui
• Format: Article
• Language: English
• Published: MDPI AG 2021-08-01
• Series: Current Oncology
• Subjects: carcinoembryonic antigen; medullary thyroid carcinoma; colon adenocarcinoma; calcitonin
• Online Access: https://www.mdpi.com/1718-7729/28/4/261
• ISSN: 1198-0052; 1718-7729

Serum carcinoembryonic antigen (CEA) is a tumor marker especially used to follow a patient with colorectal cancer. However, it is non-specific and could be increased in several cancers and some benign conditions. We report the case of a 70-year-old man followed since 2014 for a left colon adenocarcinoma with the persistence of an increased CEA. There was no evidence of recurrence, but a right lobar thyroid nodule without a significantly increased uptake was incidentally discovered on the CT scan of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT. We suspected a medullary thyroid carcinoma (MTC) explaining the persistent elevation of CEA. Plasma calcitonin levels were 47 ng/L (N < 10). Fine needle aspiration cytology found atypia of undetermined significance and the patient was reluctant to undergo surgery without any further exploration. We performed a ¹⁸F-fluorodihydroxyphenylalanine (¹⁸F-FDOPA) PET/CT preoperatively which revealed a punctiform focus of the right thyroid lobe corresponding to a pT1aN1aMxR0 medullary thyroid carcinoma, histopathologically confirmed. This case highlights that despite the potential usefulness of ¹⁸F-FDG PET/CT in case of an unknown source of elevated CEA this imaging may be falsely negative as in the case of MTC and should lead to further explorations.