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Lee, Ahn, Kim, Jang, Koh, Lee, Kim, and Lee: Solitary Pulmonary Metastasis of a Thyroid Papillary Microcarcinoma, Masquerading as Primary Lung Cancer
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2011; 26(1): 78-83.

Published online: 31 March 2011

DOI: https://doi.org/10.3803/EnM.2011.26.1.78

Solitary Pulmonary Metastasis of a Thyroid Papillary Microcarcinoma, Masquerading as Primary Lung Cancer

Jong Hwan Lee, Se Jin Ahn, Hyung Jin Kim, Sang Eon Jang, Jae Soo Koh1, Yun Yong Lee, Cheol Hyeon Kim, Jae Cheol Lee

Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.

1Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea.

Corresponding author: Jae Cheol Lee. Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 215-4 Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-3010-3208, Fax: +82-2-3010-6961, jclee@amc.seoul.kr

Received 1 July 2010       Accepted 24 August 2010

Copyright © 2011 Korean Endocrine Society

Abstract

Although pulmonary metastasis of thyroid cancer is not uncommon, it mostly occurs as multiple discrete nodules on the lung parenchyma. Because thyroid cancer presenting with an isolated large lung mass is extremely rare and the diagnosis is frequently based on small pieces of tissue obtained by a fine needle, the wrong diagnosis such as lung cancer is prone to be made. A 60-year-old man was admitted for evaluation of a lung mass detected on chest radiography. Cytological examination of the bronchial washing specimens suggested adenocarcinoma. Surgery for early lung cancer was performed considering that no other abnormalities were found during the work-up that included 18-fludeoxyglucose positron emission tomography computer tomography (18FDG-PET/CT). Unexpectedly, the diagnosis of papillary thyroid cancer with lung metastasis was made, which prompted us to evaluate the thyroid gland and then remove the primary cancer by subsequent operation. Although it is uncommon, physician should be aware of this possibility, which could help to avoid the wrong diagnosis. Here we report on a typical case of solitary pulmonary metastasis of thyroid cancer and we summarize the previously reported cases with a review of the relevant literature.

Keywords: Lung Neoplasm, Neoplasm Metastasis, Thyroid Cancer

Figures and Tables

Fig. 1
Simple chest X-ray, CT and 18FDG-PET/CT findings. A. Chest radiograph showed a round mass behind cardiac shadow in left lower lobe (arrow). B. An about 2.9 cm-sized mass in the central portion of left lower lobe was found on chest CT. C. 18FDG-PET/CT revealed a hypermetabolic lesion with SUV of 4.5.
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Fig. 2
Pathologic findings. A, B. Pathologic examination of the resected lung tumor showed typical tumor cells of papillary thyroid carcinoma (H&E staining; A, × 40) with nuclear groove (arrowhead) and intranuclear inclusions (arrow) (H&E staining; B, × 400). C. The immunohistological staining for thyroglobulin was strong-positive.
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Fig. 3
Neck CT, 18FDG-PET/CT and ultrasound findings. A. 0.6 cm calcified nodule in left thyroid gland (arrow) and multiple small cysts and nodular hyperplasia in both thyroid glands were noted. B. There was no definite FDG uptake around the calcified nodule. C. An about 0.6 cm dense, round calcified nodule with posterior shadowing in left thyroid gland (arrow) and was found on thyroid ultrasonogram.
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Table 1
Reported cases of a solitary pulmonary metastasis from thyroid cancer
enm-26-78-i001

LLL, left lower lobe; LUL, left upper lobe; RLL, right lower lobe; RML, right middle lobe; RUL, right upper lobe.

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