Lenvatinib Administered via Nasogastric Tube in Poorly Differentiated Thyroid Cancer

Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma: A case report and review of literature

BACKGROUND

Although papillary thyroid microcarcinoma (PTMC) is not considered a threatening tumor, in some cases, it can be aggressive. Metastatic thrombosis of papillary thyroid carcinoma, follicular thyroid carcinoma, Hürthle cell carcinoma, poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature, but there have been no reports about PTMC.

CASE SUMMARY

A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination. She had no symptoms, and the physical examination showed no positive signs. Subsequent ultrasonography-guided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance, with some actively growing cells (TBSRTC III) and the BRAF^V600E mutation not present. This patient underwent left thyroidectomy, isthmus lobectomy, prophylactic central lymph node dissection and thromboembolectomy. Postoperative pathology showed papillary microcarcinoma of the left thyroid, and the thrombus in the middle thyroid vein was a tumor thrombus.

CONCLUSION

Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC, but it does exist. Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid, and we strongly suggest close follow-up of these patients.

Nasogastric administration of lenvatinib solution in a mechanically ventilated patient with rapidly growing anaplastic thyroid cancer

SUMMARY

A 54-year-old woman was referred to our hospital with a cervical tumor. CT revealed a cervical tumor extending to the upper mediastinum, tracheal deviation and tumor infiltration in the cervical vessels. She was followed-up because no diagnosis of malignancy was made by cytology. However, 2 months later, a CT scan showed enlargement of the tumor and tracheal stenosis, and a surgical biopsy was performed and she was diagnosed with anaplastic thyroid cancer (ATC). The tracheal tube with tracheal stenosis could not be removed due to the rapid growth of the tumor, necessitating management by mechanical ventilation. Due to the difficulty of surgical resection, she was treated with lenvatinib. A lenvatinib solution was made and administered via a nasogastric tube. After lenvatinib treatment, the tumor volume decreased and the tracheal stenosis improved. The tracheal tube was removed and oral intake became possible. She was discharged and received ambulatory lenvatinib therapy. The tumor was significantly reduced in size, but gradually grew and was exposed through the cervical wound 6 months later. Esophageal perforation occurred 10 months after the start of treatment. Lenvatinib was re-administered via a nasogastric tube. Eleven months later, the patient died of massive bleeding from the exposed cervical tumor. Patients with advanced ATC may require management with mechanical ventilation for airway stenosis or with a nasogastric tube for esophageal stenosis and perforation. We experienced a case in which lenvatinib was safely administered via a nasogastric tube while performing mechanical ventilation.

LEARNING POINTS

An anaplastic thyroid cancer patient under mechanical ventilator management was treated with lenvatinib via a nasogastric tube. The lenvatinib solution can easily be prepared and administered via a nasogastric tube. The lenvatinib solution was effective for a patient with difficulty in oral intake. Lenvatinib could also improve the prognosis of an anaplastic thyroid cancer patient with severe airway and esophageal trouble.