Journal List > J Korean Endocr Soc > v.22(4) > 1003377

Kim, Kim, Oh, Hwang, Jung, Jung, Kang, Min, Lee, Lee, Kim, and Chung: Solitary Papillary Thyroid Microcarcinoma (0.3 cm in Diameter) Presenting Multiple Distant Metastases at the Time of Diagnosis


Papillary thyroid microcarcinoma (PTMC) is defined as being 1 cm or less in diameter. Although the prognosis of PTMC is known to be more favorable than that of papillary thyroid carcinoma greater than 1 cm in diameter, pathologic factors suggesting aggressiveness, such as multifocality and lymph node invasion, have been reported to be highly prevalent in PTMC. However, the rate of distant metastasis in patients with PTMC is very low. Many investigators have reported that initial distant metastasis was detected only in patients with PTMC greater than 0.4 cm in diameter, however these cases have involved only one organ, usually the lung. We report here on an extremely unusual case of solitary PTMC (0.3 cm in diameter) presenting multiple distant metastases at the time of diagnosis.

Figures and Tables

Fig. 1
Chest PA shows diffuse micronodular opacity at both lungs.
Fig. 2
Chest CT shows innumerable pulmonary metastatic nodules in both lungs and pericardial & right pleural effusions.
Fig. 3
Bone scan shows multiple bone metastasis in the C-spine, upper T-spine, L-spine, sacrum, bilateral pelvic bones, bilateral proximal femurs, and bilateral ribs.
Fig. 4A
PET shows focal increased FDG uptake in the right thyroid gland and cervical spine.
Fig. 4B
PET shows increased FDG uptake in C4, C6, C7, T1-T4 spines and sternum.
Fig. 5
Histologic findings of the tumor. The tumor shows proliferation of microfollicles with nuclear pseudoinclusion and optically clear-appearing nuclei (H&E stain, ×400).
Fig. 6
I-131 Whole body scan shows hot increased uptake in left anterior neck of thyroid bed, mild diffuse increased uptake in both lung field and ovoid shaped increased uptake in left lower lung


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