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Laura Agate Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Francesca Bianchi Unit of Endocrine and Oncological Nuclear Medicine Therapy, Diagnostic and Imaging Department, University of Pisa, Pisa, Italy

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Federica Brozzi Unit of Endocrine and Oncological Nuclear Medicine Therapy, Diagnostic and Imaging Department, University of Pisa, Pisa, Italy

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Pierina Santini Unit of Endocrine and Oncological Nuclear Medicine Therapy, Diagnostic and Imaging Department, University of Pisa, Pisa, Italy

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Eleonora Molinaro Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Valeria Bottici Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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David Viola Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Loredana Lorusso Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Paolo Vitti Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Rossella Elisei Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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values and metastatic lesions detected by ptWBS. Three out of 4 cases with distant metastases had a serum Tg value > 10 ng/mL (Fig.  1 ). Fig. 1. Serum Tg values in patients with 131 I uptake outside the thyroid bed detected by ptWBS. No

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M. Schlumberger Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave-Roussy and University Paris Sud, Villejuif, France

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L. Bastholt Department of Oncology, Odense University Hospital, Odense, Denmark

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H. Dralle Department of Surgery, Martin Luther University, Halle-Wittenberg Medical Faculty, Halle/Saale, Germany

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B. Jarzab MSC Memorial Cancer Center and Institute of Oncology, Gliwice, Poland

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F. Pacini Department of Endocrinologia, University of Siena, Siena, Italy

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J.W.A. Smit Department of Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands

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(MTC) accounts for less than 5% of all thyroid cancers [ 1 , 5 ]. Distant metastases are observed at presentation in 7–23% of MTC patients [ 1 , 5 ] and can be imaged with standardized protocols [ 6 ]. Symptomatic clinical disease will occur in one to

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Pedro Weslley Souza Rosario Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

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Gabriela Franco Mourão Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

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Pedro Henrique Lopes Oliveira Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

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Tulio Henrique Silva Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

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the aggressive subtype, and (iv) absence of lymph node (LN) involvement and extrathyroidal extension (ETE) apparent on ultrasonography (US) and of clinically detectable distant metastases [ 1 - 5 ]. Thus, the safe selection of candidates for AS largely

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Francesca Orsolini Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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Alessandro Prete Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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Pierpaolo Falcetta Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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Domenico Canale Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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Fulvio Basolo Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy

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Greta Alì Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy

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Francesca Manassero Division of Urology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy

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Paolo Vitti Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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Rossella Elisei Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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Eleonora Molinaro Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy

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). In 30–50% of the cases, MTC is accompanied by metastases in cervical and/or paratracheal lymph nodes, and the tumor spreads also to the upper and anterior mediastinal lymph nodes. Distant metastases are present at the diagnosis in 10–15% of patients

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Daniela Cavaco Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal

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Ana Filipa Martins Department of Endocrinology and Diabetes, Hospital da Luz, Lisbon, Portugal

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Rafael Cabrera Department of Patology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal

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Helena Vilar Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal

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Valeriano Leite Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
Nova Medical School, Lisbon, Portugal

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and/or stimulated Tg, raising anti-Tg antibodies, or evidence of loco-regional or distant metastases. For each patient, data was recorded regarding age, gender, signs/symptoms at presentation, biochemical parameters, US and cytological findings, type

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Giovanni Mauri Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy

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Laszlo Hegedüs Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark

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Steven Bandula Interventional Oncology Service, University College Hospital, London, United Kingdom

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Roberto Luigi Cazzato Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France

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Agnieszka Czarniecka The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

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Oliver Dudeck Center for Microtherapy, Klinik Hirslanden, Zurich, Switzerland

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Laura Fugazzola Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Romana Netea-Maier Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

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Gilles Russ Thyroid and Endocrine Tumors Unit, La Pitie-Salpetriere Hospital, Sorbonne University, Paris, France

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Göran Wallin Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

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Enrico Papini Department of Endocrinology & Metabolism, Ospedale Regina Apostolorum, Albano, Italy

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therapy of incidentally found indolent cervical DTC recurrences [ 13 ]. DTCs can result in distant metastases in up to 10% of cases, with lung and bone representing the 2 most commonly involved organs [ 14 ]. Various therapy options are currently

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Anne-Sophie Bertrand Department of Interventional Radiology Imaging, Antoine Lacassagne Cancer Research Center, Nice, France

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Antoine Iannessi Department of Interventional Radiology Imaging, Antoine Lacassagne Cancer Research Center, Nice, France

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Isabelle Peyrottes Department of Anatomopathology, Antoine Lacassagne Cancer Research Center, Nice, France

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Alexis Lacout Department of Radiology, Centre médico-chirurgical ELSAN, Aurillac, France

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Antoine Thyss Department of Oncology, Antoine Lacassagne Cancer Research Center, Nice, France

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Pierre-Yves Marcy Department of Interventional Radiology and Diagnostic Imaging, Polyclinique Les Fleurs Groupe ELSAN, Ollioules, France

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Established Facts Distant tumor spread from differentiated thyroid cancer is rare. The most common metastatic sites include bone and lung. Metastases to brain, eye, breast, liver, kidney, muscle, and skin are infrequent

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Simona Censi Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Elisabetta Cavedon Familial Tumor Unit, Veneto Institute of Oncology, (IOV)-IRCCS, Padua, Italy

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Sara Watutantrige-Fernando Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Susi Barollo Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Loris Bertazza Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Jacopo Manso Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Maurizio Iacobone Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy

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Davide Nacamulli Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Francesca Galuppini Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Gianmaria Pennelli Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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Caterina Mian Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

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–4 cm, there is always central lymph node involvement. Distant metastases are to be expected when preoperative basal Ctn levels are higher than 500 pg/mL. What Does This Case Report Add? We describe a case of medullary thyroid

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Markus Eszlinger Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Heritage Medical Research Building, Calgary, Alberta, Canada
Institute of Pathology, University Hospital Halle (Saale), Halle (Saale), Germany

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Paul Stewardson Department of Medical Science and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada

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John B McIntyre Precision Oncology Hub Laboratory, Alberta Health Services, Tom Baker Cancer Centre, Calgary, Alberta, Canada

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Adrian Box Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

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Moosa Khalil Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

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Martin Hyrcza Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

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Konstantin Koro Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

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Dean Ruether Section of Medical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada

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Jiahui Wu Department of Medical Science and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada

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Ralf Paschke Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Heritage Medical Research Building, Calgary, Alberta, Canada

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). In a Massachusetts General Hospital series of primary thyroid carcinoma, NTRK fusions were found in 3.1% of cases and 6/11 patients with NTRK fusions had distant metastases ( 12 ). In a series of papillary thyroid carcinomas (PTCs), NTRK fusions

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Marko Stojanović Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Sandra Pekić Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Mirjana Doknić Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Dragana Miljić Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Slavica Ćirić Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Aleksandar Diklić Faculty of Medicine, University of Belgrade
Endocrine Surgery Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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Svetislav Tatić Faculty of Medicine, University of Belgrade
Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia

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Miloje Joksimović Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia

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Emilija Manojlović-Gačić Faculty of Medicine, University of Belgrade
Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia

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Milica Skender-Gazibara Faculty of Medicine, University of Belgrade
Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia

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Vera Popović Faculty of Medicine, University of Belgrade
Neuroendocrine Department, Diabetes and Metabolic Diseases, Clinical Center of Serbia
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia

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report highlights difficulties in diagnosing sellar masses when the primary malignancy is undiagnosed. Not only was the primary malignancy not known but there were no other distant metastases either. Of particular challenge was the management of the

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