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Yang CY, Chen XW, Tang D, Yang WJ, Mi XX, Shi JP, Du WD. Hepatopulmonary metastases from papillary thyroid microcarcinoma: A case report. World J Clin Cases 2022; 10:4661-4668. [PMID: 35663055 PMCID: PMC9125277 DOI: 10.12998/wjcc.v10.i14.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/18/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Papillary thyroid microcarcinoma (PTMC) accounts for the majority of PTC cases. However, concurrent pulmonary and hepatic metastases of PTMC are rarely seen. Here, we present a patient with coexisting liver and lung metastases from PTMC. CASE SUMMARY We describe a 26-year-old woman with PTMC with multiple concurrent metastases. After 3 d of unexplained fever, she was admitted to our hospital. Her thyroid functional tests were abnormal. Her positron emission tomography (PET)/magnetic resonance imaging (MRI) examination showed increased fluorodeoxyglucose (FDG) metabolism and space-occupying lesions in the left lobe of the thyroid. Additionally, PET/MRI images revealed multiple nodules in the lung and liver with increased FDG metabolism. Chest computer tomography (CT) showed multiple pulmonary metastases. Abdominal ultrasound and liver MRI showed multiple space-occupying lesions in the liver. The patient underwent total thyroidectomy and central lymph node dissection. Postoperative pathological analysis showed a papillary microcarcinoma multiplex in the left lobe of the thyroid. A diagnosis of hepatopulmonary metastases from papillary thyroid microcarcinoma was made. The patient was given iodine-131 treatment one year after the surgery. She recovered well after the operation, and the incision healed well. After discharge, she was treated with oral levothyroxine sodium tablets, and symptomatic and supportive treatments were also given to promote radioactive excretion and prevent bone marrow suppression by iodine-131 treatment. CONCLUSION Since patients with thyroid cancer concurrent with hepatopulmonary metastases have rarely been reported, our case will highlight the clinical and pathological profiles of these patients.
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Affiliation(s)
- Chuan-Yu Yang
- Department of Hepatobiliary Surgery, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310003, Zhejiang Province, China
| | - Xuan-Wu Chen
- Department of Hepatobiliary Surgery, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310003, Zhejiang Province, China
| | - Dong Tang
- Department of Medical Imaging, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Wen-Jun Yang
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Xiao-Xiao Mi
- Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Jun-Ping Shi
- Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Wei-Dong Du
- Department of Hepatobiliary Surgery, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310003, Zhejiang Province, China
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Dabir M, Limberg J, Krieg A, Antke C, Sawicki LM. Radioiodine Uptake of a Benign Peritoneal Cyst on 131-I Whole-body Scan in a Patient Treated for Papillary Thyroid Cancer. Nuklearmedizin 2021; 61:130-131. [DOI: 10.1055/a-1699-1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mardjan Dabir
- Department of Nuclear Medicine, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Juliane Limberg
- Institute of Pathology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Christina Antke
- Clinic of Nuclear Medicine, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Lino M. Sawicki
- Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
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Long-Term Outcomes After Hepatic and Pancreatic Resections for Metastases from Thyroid Cancer: a Systematic Review of the Literature. J Gastrointest Cancer 2019; 50:9-15. [PMID: 30618003 DOI: 10.1007/s12029-018-00196-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of our systematic review was to evaluate the long-term outcomes of surgical resection as a treatment strategy for liver and pancreatic metastases from thyroid cancer (TC). METHODS A systematic search of three electronic databases for articles published up to October 2018 was conducted. All appropriate observational studies and case reports which reported outcomes from patients with TC metastatic to the liver or pancreas were considered eligible for inclusion in the present systematic review. RESULTS A total of 15 studies, which comprised of 16 patients that underwent hepatic or pancreatic resection for TC metastasis, were included in the present systematic review; among them, 5 presented with metastasis to the liver, whereas 11 had pancreatic metastatic disease. The median time interval between the initial thyroidectomy and the diagnosis of metastases (either hepatic or pancreatic) was 60 months (SE 23.8, 95% CI 13.3-106.7) for the entire cohort and the mean overall survival was 37.6 months (SE 8, 95% CI 22-53.3). Five patients with pancreatic metastases presented with recurrence whereas no recurrences were noted in patients with liver metastases. CONCLUSIONS Surgical resection of liver and pancreatic metastases from TC seems to be a safe and efficient treatment option for selected patients. In that setting, long-term outcomes in patients with resected TCLM are encouraging given the absence of recurrence as reported from the included studies, whereas in the case of TCPM, survival is limited due to advanced disease at diagnosis and recurrence rates.
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Palaniswamy SS, Subramanyam P. Unusual Sites of Metastatic and Benign I 131 Uptake in Patients with Differentiated Thyroid Carcinoma. Indian J Endocrinol Metab 2018; 22:740-750. [PMID: 30766811 PMCID: PMC6330860 DOI: 10.4103/ijem.ijem_70_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Differentiated thyroid carcinoma (DTC) is the most common pathological type of thyroid carcinoma, which includes papillary and follicular subtypes. DTC is usually indolent, characterized by good prognosis, and long-term survival. Total thyroidectomy is the mainstay of treatment in DTC which is followed by diagnostic whole body 131I (WBI) scan. Like other primary malignancies of the head and neck, DTC follows a consistent pattern of spread in the cervical LNs. The central compartment, level VI and VII, is the first sentinel node followed by spread to the lateral compartments levels II-V, followed by the contralateral side. Inspite of nodal involvement, DTC usually have a favourable outcome. Presence of extrapulmonary distant metastases could predict a poor prognosis for high-dose 131I therapy. However, distant metastasis occurs often as a grave event and mortality rates vary depending on metastatic sites. AIM AND OBJECTIVES A range of rare 131I concentrating DTC deposits in sella, orbit, choroid, skeletal muscles, liver, skin, costochondral soft tissue, pancreas and kidney, and a few benign 131I concentrating sites are being depicted. MATERIALS AND METHODS Metastatic sites from DTC can be easily identified by performing a whole body 131I (WBI) scan along with a stimulated thyroglobulin (Tg) estimation (TSH >30 uIU/ml). Apart from thyroid and thyroid-related diseases, certain benign non-thyroidal pathologies can concentrate radioiodine (131I). From 13,000 of our patients who underwent radioiodine scan for thyroid cancer, we have selected a few cases of 131I concentrating benign and malignant lesions for illustration. RESULTS Out of 13000 DTC patients who underwent whole body 131I scintigraphy in our department from Jan 2007 till Mar 2018, 25 patients revealed benign sites of 131I uptake. 61 % patients had residual thyroid tissue with or without associated nodal involvement. Remaining patients had distant metastases. Rare sites of functioning thyroid metastases and benign sites of I 131 uptake have been selected for illustration. CONCLUSION Apart from the WBI (two-dimensional, planar) images, single-photon emission computed tomography-computed tomography (SPECT-CT) has been incremental in localizing benign lesions which greatly depends on their location. This pictorial review highlights the need to create an awareness to detect metastatic deposits of DTC at unexpected sites. Otherwise patients will need further investigation to rule out unsuspected sites of functioning distant metastases.
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Affiliation(s)
- Shanmuga S. Palaniswamy
- Department of Nuclear Medicine and Molecular Imaging, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala, India
| | - Padma Subramanyam
- Department of Nuclear Medicine and Molecular Imaging, Amrita Institute of Medical Sciences, Amrita Vishwavidyapeetham, Cochin, Kerala, India
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5
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Saito Y, Sugino K, Takami H, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Kawakubo H, Ito K, Kitagawa Y. Clinical Status and Treatment of Liver Metastasis of Differentiated Thyroid Cancer Using Tyrosine Kinase Inhibitors. World J Surg 2018; 42:3632-3637. [PMID: 29766229 DOI: 10.1007/s00268-018-4676-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of patients with liver metastasis of differentiated thyroid carcinoma (DTC) has not been sufficiently defined, because liver metastasis of DTC has been described mostly as case reports. Additionally, such patients are considered end-of-treatment responders. A relatively new approach using tyrosine kinase inhibitors (TKIs) may provide opportunities to manage systemic metastasis. This study aims to define the clinical features of DTC patients with liver metastasis and evaluate the benefits of TKIs. METHODS We retrospectively analyzed clinical features of 29 patients (mean age 67.8 years) diagnosed with liver metastasis of DTC at our institution between January 1981 and May 2017. RESULTS All patients had distant metastasis at other organ sites upon diagnosis of liver metastasis; 41% of them developed new metastasis afterward. Management after diagnosis of liver metastasis comprised palliative care (48%), radioactive iodine therapy (28%), and TKI therapy (24%). The median survival after diagnosis of liver metastasis was only 4.8 months. Survival rates were significantly better in patients with performance statuses between 0 and 2 on the Eastern Cooperative Oncology Group scale at diagnosis of liver metastasis (n = 22, 76%) treated with TKI compared to those who were not (P = 0.017; log-rank test; hazard ratio 0.19). One-year survival rates were 71.4 and 26.7% for patients treated with or without TKI, respectively. CONCLUSIONS Patients with liver metastasis had poor clinical prognosis. When other distant metastases existed at diagnosis of liver metastasis, TKI therapy was considered an effective therapeutic option for patients with liver metastasis of DTC.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Papillary, Follicular/drug therapy
- Carcinoma, Papillary, Follicular/mortality
- Carcinoma, Papillary, Follicular/pathology
- Female
- Humans
- Liver Neoplasms/drug therapy
- Liver Neoplasms/mortality
- Liver Neoplasms/secondary
- Male
- Middle Aged
- Phenylurea Compounds/therapeutic use
- Protein-Tyrosine Kinases/therapeutic use
- Quinolines/therapeutic use
- Retrospective Studies
- Thyroid Cancer, Papillary/drug therapy
- Thyroid Cancer, Papillary/mortality
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Yoshiyuki Saito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Hiroshi Takami
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Ibrahim EY, Busaidy NL. Treatment and surveillance of advanced, metastatic iodine-resistant differentiated thyroid cancer. Curr Opin Oncol 2017; 29:151-158. [PMID: 28141684 DOI: 10.1097/cco.0000000000000349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This review will focus on the management and treatment of metastatic thyroid cancer that is radioactive iodine refractory and review the new drugs and their mechanism of actions as well as their adverse events. RECENT FINDINGS Until recently, there were no efficacious therapeutic modalities for these patients. With advancement in knowledge and research of the molecular aberrations and oncogenic mutations in thyroid cancer as well as further understanding the role of angiogenesis in tumor growth molecular pathogenesis, novel targeted therapies are available for these patients. Some of these drugs have successfully prolonged progression free survival and are now Food and Drug Administration approved. Additional agents are approved for the treatment of other types of cancers and are currently under investigation for differentiated thyroid cancer treatment. SUMMARY Differentiated thyroid cancer (papillary and follicular) is the most common endocrine malignancy. It is generally known to have an excellent prognosis and patients are usually cured with the conventional primary treatments including surgery, radioactive iodine, and thyroid stimulating hormone suppression. A minor proportion of patients do not fully recover mainly because they develop radioactive iodine-resistant disease. These patients have few treatment options, which we aimed to describe here.
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Affiliation(s)
- Eiman Y Ibrahim
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas - M.D. Anderson Cancer Center, Houston, Texas, USA
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Isolated Liver Metastasis in Hürthle Cell Thyroid Cancer Treated with Microwave Ablation. Case Rep Endocrinol 2017; 2017:2790741. [PMID: 28163939 PMCID: PMC5253501 DOI: 10.1155/2017/2790741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/25/2016] [Indexed: 12/23/2022] Open
Abstract
Hürthle cell thyroid cancer (HCTC) is a less common form of differentiated thyroid cancer. It rarely metastasizes to the liver, and when it does, the metastasis is almost never isolated. Here we report a 62-year-old male with widely invasive Hürthle cell thyroid cancer, who underwent total thyroidectomy and received adjuvant treatment with I-131 with posttreatment scan showing no evidence of metastatic disease. His thyroglobulin however continued to rise after that and eventually an isolated liver metastasis was identified. He underwent laparoscopic microwave ablation of the liver metastasis, with dramatic decline in thyroglobulin and no structural disease identified to date. This case highlights the rare occurrence of isolated liver metastasis from HCTC and also illustrates the utility of thermoablation as an alternative to surgical resection in the treatment of small isolated liver metastases from HCTC.
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8
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Battoo AJ, Rasool Z, Sheikh ZA, Haji AG. Follicular thyroid carcinoma presenting as solitary liver metastasis: a case report. J Med Case Rep 2016; 10:347. [PMID: 27912795 PMCID: PMC5135783 DOI: 10.1186/s13256-016-1140-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background Distant metastasis from differentiated thyroid carcinoma at presentation is rare and isolated liver metastasis on presentation is almost unknown. We report a case of primary follicular carcinoma of the thyroid with isolated liver metastasis at presentation. Case presentation A 65-year-old man of Kashmiri origin presented to our tertiary referral center with obstructive jaundice; he was evaluated with magnetic resonance cholangiopancreatography and positron emission tomography-computed tomography. Positron emission tomography-computed tomography documented a lesion in his liver in addition to a metabolically active thyroid nodule. Fine needle aspiration cytology of the liver lesion supplemented with immunohistochemical analysis using thyroid transcription factor 1 confirmed the lesion as being an isolated metastasis from the primary thyroid lesion (which on fine needle aspiration cytology showed follicular architecture). Conclusions To best of our knowledge, this is first reported case of primary differentiated thyroid carcinoma presenting with isolated liver metastasis manifesting as obstructive jaundice.
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Affiliation(s)
- Azhar J Battoo
- Surgical Oncology (Head and Neck Services), Sheri Kashmir Institute of Medical Sciences, Srinagar, 190011, India.
| | - Zubaida Rasool
- Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Srinagar, 190011, India
| | - Zahoor A Sheikh
- Surgical Oncology, Sheri Kashmir Institute of Medical Sciences, Srinagar, 190011, India
| | - Altaf G Haji
- Surgical Oncology, Sheri Kashmir Institute of Medical Sciences, Srinagar, 190011, India
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9
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Lamartina L, Deandreis D, Durante C, Filetti S. ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach. Eur J Endocrinol 2016; 175:R185-202. [PMID: 27252484 DOI: 10.1530/eje-16-0088] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/31/2016] [Indexed: 12/18/2022]
Abstract
The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is, though, moving toward more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow-up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short- and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome.
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Affiliation(s)
- Livia Lamartina
- Department of Internal Medicine and Medical SpecialtiesUniversity of Rome Sapienza, Rome, Italy
| | - Désirée Deandreis
- Department of Nuclear Medicine and Endocrine OncologyGustave Roussy and University Paris Saclay, Villejuif, France
| | - Cosimo Durante
- Department of Internal Medicine and Medical SpecialtiesUniversity of Rome Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Department of Internal Medicine and Medical SpecialtiesUniversity of Rome Sapienza, Rome, Italy
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10
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Kunawudhi A, Promteangtrong C, Chotipanich C. A case report of hyperfunctioning metastatic thyroid cancer and rare I-131 avid liver metastasis. Indian J Nucl Med 2016; 31:210-4. [PMID: 27385894 PMCID: PMC4918487 DOI: 10.4103/0972-3919.183616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Thyroid cancer is usually, relatively hypofunctional; most patients with thyroid cancer are clinically euthyroid. The combination of thyroid cancer and thyrotoxicosis is not common. We herein, report a case of follicular thyroid cancer with hyperfunctioning metastasis in a 43-year-old woman who presented with thyrotoxicosis, a cold right thyroid nodule, and low I-131 uptake at the thyroid bed. An additional total body scan with I-131 revealed a large radioiodine avid osteolytic bone metastasis with soft tissue masses and liver metastasis. The patient received treatment with total thyroidectomy, methimazole, and I-131 at a cumulative dose of 600 mCi along with recombinant human thyroid-stimulating hormone before the first I-131 treatment and palliative radiation. The patient had normal liver function test and experienced a mild degree of bone marrow suppression after I-131. At the 2-year follow-up, the patient was still alive with the progression of bone metastases but was doing well with less severe thyrotoxicosis, good ambulation, and an Eastern Cooperative Oncology Group performance status of 2. Clinicians should be aware of the unusual concurrent presentation of thyrotoxicosis and thyroid cancer, a differential diagnosis in patients with thyrotoxicosis and low or normal radioiodine uptake over the neck and also potential pitfalls during radionuclide treatment.
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Affiliation(s)
- Anchisa Kunawudhi
- National Cyclotron and PET Centre, Division of Nuclear Medicine, Chulabhorn Hospital, Bangkok, Thailand
| | | | - Chanisa Chotipanich
- National Cyclotron and PET Centre, Division of Nuclear Medicine, Chulabhorn Hospital, Bangkok, Thailand
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11
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Farina E, Monari F, Tallini G, Repaci A, Mazzarotto R, Giunchi F, Panzacchi R, Cammelli S, Padula GDA, Deodato F, Pasquali R, Fanti S, Fiorentino M, Morganti AG. Unusual Thyroid Carcinoma Metastases: a Case Series and Literature Review. Endocr Pathol 2016; 27:55-64. [PMID: 26662609 DOI: 10.1007/s12022-015-9410-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission.
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Affiliation(s)
- Eleonora Farina
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Fabio Monari
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy.
| | - Giovanni Tallini
- Anatomic Pathology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Bellaria Hospital, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Renzo Mazzarotto
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Integrata, Ospedale Civile Maggiore, Piazzale Aristide Stefani 1, Verona, Italy
| | - Francesca Giunchi
- Pathology Unit of the "F. Addarii" Institute of Oncology, Department of Oncology and Hematology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Riccardo Panzacchi
- Department of Pathology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Gilbert D A Padula
- Radiation Oncology Department, The Lacks Cancer Center, Saint Mary's Health Care, 250 Cherry St SE, Grand Rapids, MI, 49503, USA
| | - Francesco Deodato
- Radiation Oncology Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart, Largo Agostino Gemelli, 1, 86100, Campobasso, Italy
| | - Renato Pasquali
- Division of Endocrinology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Michelangelo Fiorentino
- Pathology Unit of the "F. Addarii" Institute of Oncology, Department of Oncology and Hematology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
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12
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Kamaleshwaran KK, Natarajan S, Mohanan V, Shinto AS. Unusual case of hepatic metastasis in follicular thyroid carcinoma detected using I-131 whole body scintigraphy and single-photon emission computerized tomography/computerized tomography. Indian J Nucl Med 2015; 30:358-9. [PMID: 26430327 PMCID: PMC4579628 DOI: 10.4103/0972-3919.164017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Papillary and follicular thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Distant metastases are rare events at the onset of DTC. Among these presentations, metastasis to the liver is even more unusual. Only 11 cases of DTC with liver metastasis were previously reported in the literature. We present a 55-year-old male on Iodine-131 whole body scintigraphy showed intense uptake in thyroid bed, metastasis in both lungs and right lobe of the liver. Radioiodine concentration in liver metastases made him amenable to high-dose radioiodine therapy patient.
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Affiliation(s)
| | - Sudhakar Natarajan
- Department of Medical Oncology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Vyshak Mohanan
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
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13
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Djenic B, Duick D, Newell JO, Demeure MJ. Solitary liver metastasis from follicular variant papillary thyroid carcinoma: A case report and literature review. Int J Surg Case Rep 2014; 6C:146-9. [PMID: 25536153 PMCID: PMC4334885 DOI: 10.1016/j.ijscr.2014.11.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/22/2014] [Accepted: 11/23/2014] [Indexed: 01/07/2023] Open
Abstract
This manuscript raises the issue of optimal treatment of isolated visceral metastases in thyroid cancer. This patient was treated unsuccessfully with multiple bouts of radioiodine before definite successful surgery to resect the metastasis. This manuscript makes physicians aware that surgery is a viable option in oligometastases of thyroid cancer.
Introduction Papillary (PTC) and follicular (FTC) thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Sites of metastases from FTC are usually osseous and those from PTC are in regional nodal basins and the lungs. Visceral metastases are rare and when they do occur, they tend do so in multiple sites. We present the case of a patient with a follicular variant of PTC and a solitary metastasis to the liver then review the relevant literature. Presentation of case An otherwise healthy 68-year-old woman was diagnosed with follicular variant papillary thyroid cancer in 2003 and subsequently underwent thyroidectomy. The patient’s endocrinologist conducted surveillance of her thyroid cancer. In 2012, due to rise in thyroglobulin, a whole body radioiodine scan was obtained which revealed an iodine-avid left liver lobe mass. Three cycles of radioiodine ablation therapy were unsuccessful and eventually the patient was referred for surgical resection. Metastatic evaluation including a PET scan was negative with the exception of an isolated enhancing 4 cm mass in segment 4B of the liver. Anatomic segmental resection of liver was performed without complications. Intraoperative ultrasonography was used to guide resection of the liver mass. Pathology reports confirmed metastatic follicular variant of PTC. Surgical margins were free of tumor. Patient was discharged home and is doing well one year after surgery. The latest thyroglobulin level was undetectable. Discussion Post-operative surveillance by PCP, endocrinologist or surgeon for patients with thyroid carcinoma should be performed routinely. If identified, a solitary liver metastasis from primary thyroid carcinoma should be considered for surgical resection. Due to sparse data available in literature, collecting more data to establish algorithms for treatment of such rare metastatic cancers may be able to aid physicians to achieve better outcomes. Conclusion Rare distant sites of metastases from DTC include eyes, pharynx, skin, muscle, ovaries, adrenal glands, kidneys, esophagus, pancreas and liver. Isolated, resectable liver metastases from PTC are exceedingly rare. Literature review revealed only 10 reported cases of liver metastases from DTC. As in our patient, solitary liver metastasis from PTC should be considered for surgical resection which offers the best chance for prolonged survival.
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Affiliation(s)
- Brano Djenic
- General Surgery Resident, Maricopa Medical Center, Department of Surgery, Phoenix, AZ, USA
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Zhang H, Zeng L, Liang C, Qiu H, Zhang M, Zhu Y, Xie C. Successful Treatment of Hurthle Cell Thyroid Carcinoma with Lung and Liver Metastasis Using Docetaxel and Cisplatin. Jpn J Clin Oncol 2012; 42:1086-90. [DOI: 10.1093/jjco/hys146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Song HJ, Xue YL, Xu YH, Qiu ZL, Luo QY. Rare metastases of differentiated thyroid carcinoma: pictorial review. Endocr Relat Cancer 2011; 18:R165-74. [PMID: 21632805 DOI: 10.1530/erc-11-0068] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Differentiated thyroid cancer (DTC) is usually indolent with good prognosis and long-term survival. However, DTC distant metastasis is often a grave event and accounts for most of its disease-specific mortality. The major sites of distant metastases are the lung and bone. Metastases to the brain, breast, liver, kidney, muscle, and skin are rare or relatively rare. Nevertheless, recognizing rare metastases from DTC has a significant impact on the clinical decision making and prognosis of patients. (131)I single photon emission computed tomography/computed tomography ((131)I-SPECT/CT) can provide both metabolic and anatomic information about a lesion; therefore, it can better localize and define the (131)I-WBS findings in DTC patients. In this pictorial review, the imaging features of a range of rare metastases from DTC are demonstrated, with a particular emphasis on the (131)I-SPECT/CT diagnostic aspect.
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Affiliation(s)
- Hong-Jun Song
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, China
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16
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Solitary spinal metastasis of Hürthle cell thyroid carcinoma. J Clin Neurosci 2010; 17:797-801. [PMID: 20359896 DOI: 10.1016/j.jocn.2009.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 09/02/2009] [Accepted: 09/04/2009] [Indexed: 11/23/2022]
Abstract
Hürthle cell carcinoma is a rare variant of differentiated thyroid cancer that occasionally forms distant metastases. However, even in the presence of metastases, patients with Hürthle cell carcinoma have a relatively good prognosis. There are few reports of Hürthle cell carcinoma metastases to the vertebral column, and none describing aggressive resection of spinal metastases. Here, we report a 68-year-old woman with a solitary metastasis of Hürthle cell carcinoma to the T1 vertebral body causing severe kyphotic deformity, myelopathy, and pain. The patient was treated with aggressive excisional decompression of the spinal cord and T1 vertebral body resection from an entirely posterior approach. Reconstruction and stabilization of the anterior spine was accomplished with a transforaminal lumbar interbody fusion allograft spacer and posterior instrumentation. We discuss aspects of the diagnosis, management, patient selection, and surgical treatment of metastatic Hürthle cell carcinoma in reference to the literature.
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Klubo-Gwiezdzinska J, Morowitz D, Van Nostrand D, Burman KD, Vasko V, Soberman M, Wartofsky L. Metastases of well-differentiated thyroid cancer to the gastrointestinal system. Thyroid 2010; 20:381-7. [PMID: 20210670 DOI: 10.1089/thy.2009.0280] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The incidence of distant metastases at the time of initial presentation of well-differentiated thyroid cancer is approximately 4%. During the course of treatment and follow-up, the prevalence of distant metastases ranges from 2% in low-risk patients up to 33% in high-risk patients. When present, distant metastases occur primarily in the lungs and, to a lesser extent, in bones. Of all sites for distant metastasis, gastrointestinal metastases of thyroid cancer are very uncommon and account for 0.5-1% of all distant metastases. SUMMARY Indications of metastases to the gastrointestinal system can be overlooked with traditional total body radioisotope scans that image the abdomen, including both diagnostic and posttherapy scans, because of the confounding presence of physiologic enteric radioactivity. When suspected in high-risk patients, other imaging procedures such as computed tomography, magnetic resonance imaging, and PET-computed tomography should be considered. This communication will review thyroid cancer metastases to the gastrointestinal system in regard to occurrence rate, diagnosis, and treatment. CONCLUSIONS Because of the extreme rarity of patients with metastases of thyroid cancer to the gastrointestinal tract, long-term follow-up data as well as information on prognosis are very limited. Aggressive management may provide symptomatic relief or palliation, but cure is unlikely once widespread metastases supervene. Attempts at complete or near-complete surgical resection of the metastases invading the digestive tract, followed by 131-I treatment, offer the best opportunity for improvement but will only rarely result in cure in selected patients.
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18
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Wertenbroek MWJLAE, Links TP, Prins TR, Plukker JTM, van der Jagt EJ, de Jong KP. Radiofrequency ablation of hepatic metastases from thyroid carcinoma. Thyroid 2008; 18:1105-10. [PMID: 18816179 DOI: 10.1089/thy.2008.0080] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is performed for various types of liver tumors. It might also have a role in the palliative treatment of liver metastases from thyroid carcinoma. SUMMARY Three patients with liver metastases of thyroid carcinoma were retrieved from our database of 125 patients who had been treated with RFA for liver tumors. In all three patients, the metastases were a sign of widespread disease, and several other treatment modalities had been performed earlier. Two patients had metastases from medullary thyroid carcinoma and had severe diarrhea. The third patient had a rapidly progressive metastasis of a follicular thyroid carcinoma. The aim of the treatment was cytoreduction with amelioration of symptoms (n = 2) and debulking with increased sensitivity for subsequent (131)I treatment. The ablation was performed via laparotomy (n = 1), laparoscopically (n = 1), or percutaneously (n = 1). One patient experienced superficial burn wounds after a long-lasting RFA procedure. Severity of symptoms was reduced significantly after RFA for a prolonged period of time. RFA induced partial tumor necrosis because of hypervascularization of the tumor in one patient. After arterial embolization the second RFA treatment induced total tumor necrosis. Local recurrences at the site of the ablated liver metastases were not encountered during follow-up. CONCLUSIONS RFA is a useful treatment modality in patients with liver metastases from thyroid carcinoma. It should be considered an adjunct to other types of treatment or for those patients in whom more regular treatment modalities are not effective or possible or are associated with increased risks.
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Affiliation(s)
- Marieke W J L A E Wertenbroek
- Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery & Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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