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Figure 18A. Anterior and posterior 12In-Pentetreotide images in a patient with extensive mediastinal carcinoid. Multiple sites of abnormal uptake are identified in the mediastinum and right lung. The patient has had a left pneumonectomy.

Medullary thyroid cancer (MTC)

MTC arises from the neuroendocrine parafollicular cells in the thyroid gland and is associated with increased secretion of calcitonin. It is usually sporadic (7580%) but may occur as an inherited autosomal dominant disorder (MEN syndromes 2A and 2B, or isolated familial MTC). In this latter population, early genetic screening (Ret oncogene) is an important part of detection; however, in patients with sporadic disease the patient is likely to present with thyroid swelling. Metastatic spread is to locoregional and mediastinal nodes, and metastasis to lung and bone is not uncommon. Primary treatment is surgical.

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