A case of multiple pulmonary metastases of papillary thyroid carcinoma showing minimal pulmonary metastases at the time of perioperative and pathological examination

Synchronous tumours are defined as two or more independent primary neoplasms of different origins diagnosed at the same time in 1 individual. Although rare, its incidence is increasing and the proper diagnosis and staging of each tumour is crucial in defining the patient prognosis and the best therapeutic choice. We present a case of a 56-year-old woman presenting with a lung adenocarcinoma and pulmonary metastases initially diagnosed as stage IV and who was started on a tyrosine kinase inhibitor (erlotinib). In the meantime, she was also diagnosed with papillary thyroid carcinoma and was submitted to complete thyroidectomy. After 6 cycles of erlotinib, thoracic CT showed a decrease in the dimensions of the primary pulmonary tumour, but an increase in the size and number of pulmonary metastases while blood tests showed elevated thyroglobulin. This therefore raised the possibility that the metastases could have originated from the thyroid carcinoma. Anatomo-pathological examination of the lung metastases confirmed this hypothesis. In conclusion, it is important to confirm the origin of metastases in synchronous tumours given this can lead to a re-staging of tumours and a different prognosis, along with other therapeutic options. A multidisciplinary team meeting is crucial to define management and therapeutic approaches for these patients.

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Occult Papillary Thyroid Carcinoma without Detection of the Primary Tumor on Preoperative Ultrasonography or Postoperative Pathological Examination: A Case Report

Case Reports in Oncology ◽

10.1159/000505831 ◽

2020 ◽

Vol 13 (1) ◽

pp. 105-112 ◽

Cited By ~ 1

Author(s):

Gai Yamashita ◽

Takahito Kondo ◽

Akira Okimura ◽

Munehide Nakatsugawa ◽

Hiroshi Hirano ◽

...

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Primary Tumor ◽

Thyroid Tissue ◽

Pathological Examination ◽

Papillary Thyroid ◽

Superficial Lobe ◽

Preoperative Ultrasonography ◽

The Right

Herein, we report a case of an occult thyroid cancer that was not detected as a primary tumor on preoperative ultrasonography or postoperative pathological examination, although a diagnosis of papillary thyroid carcinoma metastasis was made owing to the presence of a mass in the right upper neck. Needle biopsy of the mass in the right upper neck revealed positive results for thyroglobulin and TTF-1 on immunostaining, and a papillary thyroid carcinoma was observed with papillary and follicular patterns. We suspected papillary thyroid carcinoma (T0N1bM0) or ectopic papillary thyroid carcinoma. Accordingly, we performed total thyroidectomy, central lymph node dissection, right lateral neck dissection, and resection of the superficial lobe of the right parotid. A postoperative pathological examination of 5-mm slices of the specimen revealed no primary tumor in the thyroid. However, a hyalinized image of the thyroid indicated that a micropapillary thyroid carcinoma might have spontaneously disappeared. As there was no normal thyroid tissue in the metastasis to the superior internal jugular lymph node, the tumor was unlikely to be an ectopic papillary thyroid carcinoma. Therefore, we made a diagnosis of a papillary thyroid carcinoma (pT0N1bM0). After surgery, we determined that the tumor belonged to a high-risk group of papillary thyroid carcinomas and a poor-prognosis group of symptomatic papillary thyroid microcarcinomas; accordingly, ablation was performed with 30 mCi iodine-131. There was no recurrence or metastasis 24 months after the first surgery.

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Childhood Papillary Thyroid Carcinoma With Miliary Pulmonary Metastases

Journal of Clinical Oncology ◽

10.1200/jco.2006.08.8732 ◽

2006 ◽

Vol 24 (36) ◽

pp. 5788-5789 ◽

Cited By ~ 14

Author(s):

Josephina C.J. Vermeer-Mens ◽

Natascha N.T. Goemaere ◽

Vibeke Kuenen-Boumeester ◽

Sabine M.P.F. de Muinck Keizer-Schrama ◽

Christian M. Zwaan ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Pulmonary Metastases ◽

Papillary Thyroid

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Case Report: A New Entity: Multiple Differentiated Variant of Papillary Thyroid Carcinoma With Advanced Clinical Behavior

Frontiers in Endocrinology ◽

10.3389/fendo.2021.654638 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jing Yang ◽

Rixiang Gong ◽

Yu Ma ◽

Jun Gao ◽

Zhihui Li ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Salivary Glands ◽

Neck Dissection ◽

Gluteus Maximus ◽

Left Lobe ◽

Pathological Examination ◽

Papillary Thyroid ◽

Metastatic Lesions ◽

Morphological Patterns

There are many histological morphological types of papillary thyroid carcinoma (PTC), but the most frequently seen types are conventional. A single PTC commonly has a conventional and/or a variant morphological pattern. PTC with multiple (more than two) well-differentiated morphological patterns are extremely rare. We herein report the rare case of a 48-year-old male with initial diaphragmatic, pancreatic, and liver tumors from PTC. Then, the PTC was discovered following resection of these tumors, an ultrasound-guided fine-needle aspiration (US-FNA) cytology of a huge mass in the thyroid’s left lobe revealed a PTC. After postoperative recovery, physical and ultrasound examinations identified an irregular large nodule in the thyroid’s isthmus and left lobe, several swollen lymph nodes in the left neck, a mass in the left gluteus maximus, and several masses in both the bilateral parotid and salivary regions. The US-FNA’s pathological examination confirmed metastatic PTCs in the left gluteus maximus and bilaterally in the parotid and salivary glands. An 18-fluorodeoxyglucose positron-emission tomography and computed tomography scan revealed abnormal uptakes in numerous locations (e.g., thyroid’s isthmus and left lobe, bilateral parotid gland, and subcutaneous tissues). The patient underwent palliative therapy—including total thyroidectomy, bilateral central neck dissection, left lateral neck dissection, and excision of the bilateral parotid and salivary glands. A whole-body scan post-therapeutic radioactive iodine ablation revealed exclusive thyroid bed uptake. The patient subsequently underwent thyroid stimulating hormone (TSH) repression therapy and chemotherapy with lenvatinib, and thereafter achieved stable clinical conditions. Further histopathological analysis of the PTC revealed multiple differentiated morphological patterns in the single tumor located in the isthmus and left lobe of the thyroid, and in some metastatic lesions. Different metastatic lesions also presented different morphological patterns of PTC. In conclusions, we identified a new entity of PTC as a multiple differentiated variant of PTC (MDV-PTC) with an aggressive clinical nature.

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Management of Papillary Carcinoma of Thyroid with Pulmonary Metastases in Institute of Nuclear Medicine and Allied Sciences, Rajshahi – Two Case Reports

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v18i2.35241 ◽

2018 ◽

Vol 18 (2) ◽

pp. 179-182

Author(s):

Md Kabiruzzaman Shah ◽

Nasrin Begum ◽

Mosharof Hossain ◽

Parvez Ahmed ◽

Sariful Islam Chawdhuary ◽

...

Keyword(s):

Nuclear Medicine ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Papillary Carcinoma ◽

Radioactive Iodine ◽

Pulmonary Metastases ◽

Case Reports ◽

Young Patients ◽

Radioactive Iodine Therapy ◽

Papillary Thyroid

Papillary thyroid carcinoma with pulmonary metastasis is relatively uncommon which can be treated with radioactive iodine therapy. Here, our experiences with two cases of papillary thyroid carcinoma with pulmonary metastases in young patients are discussed.Bangladesh J. Nuclear Med. 18(2): 179-182, July 2015

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