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Jeong, Shin, Son, Lee, Kim, Kie, Choi, Hong, Hahn, Lee, and Kim: A Case of Pleural Metastasis from Papillary Tthyroid Carcinoma
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(2): 188-193.

Published online: 31 August 2007

DOI: https://doi.org/10.4046/trd.2007.63.2.188

A Case of Pleural Metastasis from Papillary Tthyroid Carcinoma

Jaeheon Jeong, M.D.1, 4, Sang Yun Shin, M.D.1, 4, Myoung Kyun Son, M.D.1, 4, Young Joo Lee, M.D.1, 4, Se Hyun Kim, M.D.1, 4, Jeong Hae Kie, M.D.2, Yoon Jung Choi, M.D.2, Yong Kook Hong, M.D.3, Chang Hoon Hahn, M.D.1, Sun-Min Lee, M.D.1, Chong Ju Kim, M.D.1

1Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

2Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

3Department of Radiology, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea.

4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Address for Correspondence: Chong Ju Kim, M.D. Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, #1232, Paeksok-dong, Ilsan-donggu, Koyang-shi, Kyunggi-do, 410-719, Korea. Phone: 82-31-900-0237, FAX: 82-31-900-0343, kom2d@netsgo.com

Received 5 April 2007       Accepted 20 July 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Lung cancer, breast cancer and lymphoma are the common oncologic causes of malignant pleural effusion, comprising more than the half of the causes. However, an endocrinologic carcinoma associated malignant effusion is very rare. Recently, we encountered a case of papillary thyroid carcinoma causing malignant effusion. An 83-year-old female patient presented with dyspnea due to massive pleural effusion in her left side. The pleural biopsy, pleural fluid cytology and breast needle aspiration biopsy results were consistent with a metastatic papillary thyroid carcinoma. Thyroid ultrasonography showed two thyroid masses, but the patient refused a thyroid biopsy. This case highlights the need for considering the possibility of papillary thyroid carcinoma when the cause of malignant pleural effusion cannot be found because one of the rare clinical manifestations of a papillary thyroid carcinoma can be dyspnea due to malignant effusion.

Keywords: Papillary thyroid carcinoma, Pleural metastasis, Malignant pleural effusion

Figures and Tables

Figure 1
Chest X-ray shows left pleural effusion and left upper mediastinal mass with tracheal deviation.
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Figure 2
Chest CT shows a highly enhancing left thyroid mass with central low density (A), enlarged left axillary lymph node (large arrow) and pleural effusion with enhanced pleural nodule (small arrow) (B), and large left anterior chest wall mass with lung invasion (large arrow) and pleural nodules (small arrows) (C).
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Figure 3
Thyroid ultrasonography shows isoechoic mass measuring 1 cm in the right thyroid (A), and large well-defined isoechoic mixed mass measuring 4.5 cm in the left thyroid (B).
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Figure 4
On Hematoxylin and Eosin (H&E) stained tissue section of the pleural biopsy specimen, a few papillary clusters of atypical cells with abundant eosinophilic cytoplasm, prominent nucleoli, and occasional nuclear grooves are observed (H&E stain, × 400).
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Figure 5
On Pap smear of breast aspiration specimen, many papillary clusters of atypical cells are noted (A) (Papanicolaou, ×40). On high power, the atypical cells show occasional nuclear grooves (dotted line) and pseudoinclusion (solid line) (B) (Papanicolau, ×400).
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Figure 6
On TTF-1 stain of pleural biopsy specimen, the tumor cells show weak positivity to TTF-1 (A)(×200), and breast aspiration specimen showed strong positivity to TTF-1 (B)(×200).
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