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Jakimów K, Tekiela N, Kozak K, Peterek R, Kwaśniewska A, Pająk J, Chudek J. Misdiagnosis Based on Neoplastic Markers-Extremely High Alpha-Fetoprotein in Patients with Intrahepatic Cholangiocarcinoma with Literature Review of the Published Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1109. [PMID: 39064538 PMCID: PMC11279150 DOI: 10.3390/medicina60071109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
Background: Alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA 19-9) are two tumor markers that are widely used in the differential diagnosis in patients with primary liver tumors. Very high levels of AFP are sporadically observed in patients with intrahepatic cholangiocarcinoma (ICC) and may cause an incorrect initial diagnosis of hepatocellular carcinoma (HCC). Methods: Two cases of tumors in cirrhotic livers were described, in which the initial diagnosis, based on very high AFP levels (Patient I: 10,464 ng/mL, Patient II: 2212 ng/mL, reference range: ≤8.04 ng/mL) was HCC. In addition, the PubMed database was searched for cases of ICC with elevated AFP. Discussion: In both individuals, liver cirrhosis was diagnosed, but there was no typical rapid "washout" in the contrast-enhanced computed tomography. Based on the histological assessment of samples obtained in the core biopsies, the initially assumed diagnosis of HCC was changed to ICC in both cases. Only nine cases of patients with ICC and high AFP levels were found in the PubMed database. The AFP levels ranged from slightly elevated to over 16,000 ng/mL. Conclusions: A very high AFP level does not necessarily correlate with the presence of HCC. Therefore, the diagnosis has to be verified histologically, when the radiological imaging is uncertain in patients with liver cirrhosis.
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Affiliation(s)
- Krzysztof Jakimów
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Natalia Tekiela
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Katarzyna Kozak
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Robert Peterek
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Anna Kwaśniewska
- Department of Radiology, The Mielecki Hospital, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jacek Pająk
- Department of Pathomorphology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland
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Piantanida E, Ippolito S, Gallo D, Masiello E, Premoli P, Cusini C, Rosetti S, Sabatino J, Segato S, Trimarchi F, Bartalena L, Tanda ML. The interplay between thyroid and liver: implications for clinical practice. J Endocrinol Invest 2020; 43:885-899. [PMID: 32166702 DOI: 10.1007/s40618-020-01208-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
A complex relationship exists between thyroid and liver in health and disease. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism. Conversely, thyroid hormones affect activities of hepatocytes and hepatic metabolism. Serum liver enzyme abnormalities observed in hypothyroidism may be related to impaired lipid metabolism, hepatic steatosis or hypothyroidism-induced myopathy. Severe hypothyroidism may have biochemical and clinical features, such as hyperammonemia and ascites, mimicking those of liver failure. Liver function tests are frequently abnormal also in hyperthyroidism, due to oxidative stress, cholestasis, or enhanced osteoblastic activity. Antithyroid drug-associated hepatotoxicity is a rare event, likely related mainly to an idiosyncratic mechanism, ranging from a mild hepatocellular damage to liver failure. Propylthiouracil-induced liver damage is usually more severe than that caused by methimazole. On the other hand, thyroid abnormalities can be found in liver diseases, such as chronic hepatitis C, liver cirrhosis, hepatocellular carcinoma, and cholangiocarcinoma. In particular, autoimmune thyroid diseases are frequently found in patients with hepatitis C virus infection. These patients, especially if thyroid autoimmunity preexists, are at risk of hypothyroidism or, less frequently, thyrotoxicosis, during and after treatment with interpheron-alpha alone or in combination with ribavirin, commonly used before the introduction of new antiviral drugs. The present review summarizes both liver abnormalities related to thyroid disorders and their treatment, and thyroid abnormalities related to liver diseases and their treatment.
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Affiliation(s)
- E Piantanida
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy.
| | - S Ippolito
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - D Gallo
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - E Masiello
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - P Premoli
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - C Cusini
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - S Rosetti
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - J Sabatino
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - S Segato
- Gastroenterology and Gastrointestinal Endoscopic Unit, Department of Specialistic Medicine, ASST Dei Sette Laghi, Varese, Italy
| | - F Trimarchi
- Accademia Peloritana Dei Pericolanti, University of Messina, Messina, Italy
| | - L Bartalena
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy.
| | - M L Tanda
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
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Celik SU, Besli D, Sak SD, Genc V. Thyroid Gland Metastasis from Cancer of the Uterine Cervix: An Extremely Rare Case Report. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 59:97-99. [PMID: 27770838 DOI: 10.14712/18059694.2016.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The thyroid gland is a relatively uncommon site for a metastatic disease, although it is richly supplied with blood. The metastases may originate from various primary sites, mainly kidney, lung, head and neck, and breast. Thyroid metastasis from cervical carcinomas is extremely rare; and only a few cases have been previously reported in the literature. In patient with thyroid nodules and an oncological history, the possibility of thyroid metastasis should be seriously considered. Despite the rarity of the metastasis of cervical carcinoma to the thyroid, it is difficult to say appropriate treatment approach for these lesions. When managing such patients, decision-making should balance the possibility of gaining long-term survival against estimation of the aggressiveness of the disease and its possible complications. Here, a case of thyroid metastasis from a squamous cell carcinoma of the uterine cervix presenting with cervical mass and difficulty in swallowing and its treatment is reported.
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Affiliation(s)
- Suleyman Utku Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey.
| | - Dilara Besli
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Serpil Dizbay Sak
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan Genc
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Anoikis-resistant cholangiocarcinoma cells display aggressive characteristics and increase STAT3 activation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:397-405. [DOI: 10.1002/jhbp.354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Dušková J, Rosa P, Přeučil P, Svobodová E, Lukáš J. Secondary or second primary malignancy in the thyroid? metastatic tumors suggested clinically: a differential diagnostic task. Acta Cytol 2014; 58:262-8. [PMID: 24903466 DOI: 10.1159/000360805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 02/23/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the algorithms employed to explore the suggestion or consideration of metastatic malignancy in the thyroid. STUDY DESIGN Thirty-seven cases with a history of malignancy (n = 21) and/or uncommon fine-needle aspiration biopsy (FNAB) findings (n = 37) were reviewed and reclassified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). RESULTS The group was heterogeneous in terms of the final histopathology results: the suggested metastasis was confirmed in only half of the cases (11/21; 52.4%). Primary thyroid malignancies were mostly nondifferentiated, medullary, or rare. However, 3 papillary carcinomas (the less common variants) were also found. Finally, 5 out of 37 cases were surprisingly benign upon histopathological investigation (uncommon repair and fibrotizing Hashimoto thyroiditis). CONCLUSIONS The metastatic nature of thyroid gland nodule(s) must be considered in cases of generalization of malignancy and/or uncommon FNAB findings. We must be as open-minded as possible from the outset. Additional techniques are helpful if available - cytoblock and immunocytochemistry can contribute substantially. Morphological comparisons with the previous malignancy are recommended whenever possible. To avoid overtreatment, cases without precise typing should not be classified as TBSRTC diagnostic category VI - malignant, but should remain in TBSRTC diagnostic category V - suspicious for malignancy. Repeated FNAB to enable additional techniques may be suggested.
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Affiliation(s)
- Jaroslava Dušková
- Cytopathology Laboratory, Institute of Pathology, 1st Medical Faculty, Charles University and Medical College, Prague, Czech Republic
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Pastore AL, Palleschi G, Manfredonia G, Maceroni P, Alvaro D, De Santis D, Ferretti S, Porta N, Di Cristofano C, Della Rocca C, Fuschi A, Al Salhi Y, Maggioni C, Moschese D, Petrozza V, Carbone A. Penile metastasis from primary cholangiocarcinoma: the first case report. BMC Gastroenterol 2013; 13:149. [PMID: 24124668 PMCID: PMC3854009 DOI: 10.1186/1471-230x-13-149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/05/2013] [Indexed: 12/17/2022] Open
Abstract
Background Metastatic penile carcinoma derived from cholangiocarcinoma (CCA) has not been previously reported in the literature. Common metastatic sites for CCA include the regional lymph nodes and adjacent organs. CCAs are not highly vascularised tumours, making hematogenous metastases uncommon. Hematogenous CCA metastases commonly occur at distant organs such as the lungs, adrenal glands, and bones. Median survival for patients with metastatic disease is generally less than 1 year. Case presentation A 74-year-old Caucasian man consulted us after having undergone penile ultrasonography for pain and increased thickness at the base of the penis after self-examination. The patient presented with a history of hepatitis C-related cirrhosis and intrahepatic CCA, diagnosed 3 years previously. A biopsy of the corpora cavernosa on both sides revealed a carcinoma harbouring the same histological and immunophenotypical features as the primary hepatic lesion. Conclusions To date, there is no case of penile or urogenital system metastasis from CCA described in the literature. Therefore, this article represents the first case report of penile metastasis from CCA.
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Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT Latina, Sapienza University of Rome, Latina, Italy.
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Moghaddam PA, Cornejo KM, Khan A. Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature. Endocr Pathol 2013; 24:116-24. [PMID: 23872914 DOI: 10.1007/s12022-013-9257-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The thyroid gland is an uncommon site for metastatic disease but cases have been well-documented in the literature, particularly in autopsy series. A retrospective review of surgical pathology and autopsy pathology database for patients with metastatic carcinoma to the thyroid was performed at the University of Massachusetts Medical Center between January 1993 to January 2013. We identified a total of 10 patients with metastatic carcinoma to the thyroid; 6 were in surgical pathology specimens out of a total of 1,295 thyroid carcinoma (0.46 %) and 4 were diagnosed at autopsy out of a total of 2,117 (0.19 %) autopsy cases during this period. Cases with direct extension of the tumor into the thyroid from local primary sites such as larynx, esophagus or soft tissues of the neck were excluded. The primary tumors in these cases comprised of four lung carcinomas, three colorectal carcinomas, a renal cell carcinoma, a pleural malignant mesothelioma, and an unknown primary. Therefore, it is important to keep intrathyroidal metastases in the differential diagnosis when evaluating a thyroid nodule, particularly in patients with a previous history of malignancy. Furthermore, a literature review reveals over 1,400 cases have been previously reported, with the most common malignancies from the kidney (34 %), lung (15 %), gastrointestinal tract (14 %), and breast (14 %).
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Chindaprasirt J, Sookprasert A, Sawanyawisuth K, Limpawattana P, Tiamkao S. Brain metastases from cholangiocarcinoma: a first case series in Thailand. Asian Pac J Cancer Prev 2013; 13:1995-7. [PMID: 22901160 DOI: 10.7314/apjcp.2012.13.5.1995] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Brain metastasis from cholangiocarcinoma (CCA) is a rare but fatal event. To the best of our knowledge, only few cases have been reported. Herein, we report the incident rate and a first case series of brain metastases from CCA. METHODS Between January 2006 and December 2010 5,164 patients were treated at Srinagarind hospital, Khon Kaen University; of those, 8 patients developed brain metastasis. Here we reviewed clinical data and survival times. RESULTS The incident rate of brain metastases from CCA was 0.15%. The median age of the patients was 60 years. Tumor subtypes were intrahepatic in 6 and hilar in 2 patients. All suffered from symptoms related to brain metastasis. Three patients were treated with whole-brain radiation therapy (WBRT), one of whom also underwent surgery. The median survival after the diagnosis of brain metastasis was 9.5 weeks (1-28 weeks). The longest survival observed in a patient in RPA class I with two brain lesions and received WBRT. CONCLUSION This is a first case series of brain metastases from CCA with the incident rate of 0.15%. It is rare and associated with short survival time.
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Affiliation(s)
- Jarin Chindaprasirt
- Medical Oncology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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