Journal List > J Korean Endocr Soc > v.22(1) > 1003411

Lee, Kim, Kim, Lee, Kim, and Koh: A Case of Thyroid Microcarcinoma with Multiple Metastases, Including Liver Metastasis

Abstract

A 65-year-old woman presented with a dry cough and multiple various sized nodules in both lungs on chest X-ray. A CT scan showed a 9.5 cm sized hypervascular mass in the liver and a 5.5 cm sized intraabdominal mass. A percutaneous needle biopsy of one of the lung nodules revealed a metastatic follicular thyroid carcinoma. Therefore, thyroid ultrasonography was performed, which revealed a 1 cm sized nodule in the right thyroid lobe. Cytology, obtained by ultrasonography guided fine needle aspiration, revealed a follicular neoplasm. The tumor cells were weakly positive on galectin-3 immunostaining, which favored a follicular carcinoma. An ultrasonography guided biopsy of the liver and EUS (endoscopic ultrasonography)-guided biopsy of the intraabdominal mass revealed a metastatic follicular thyroid carcinoma in the liver and peritoneum. We report a very rare case of a follicular thyroid microcarcinoma, with multiple metastases to the lung, liver and peritoneum. (J Kor Endocrinol Soc 22:50~54, 2007)

Figures and Tables

Fig. 1
Liver dynamic CT shows large hypervascular mass (diameter; 9.5 cm) in anterior segment of right liver. The mass has capsular enhancement and central necrosis (A). Fusion whole body PET shows hypermetabolic lesion in liver (SUVmax = 30.8) (B). CT shows mass (diameter-5.5 cm) with calcification between liver and stomach (C). Fusion whole body PET shows hypermetabolic lesion between liver and stomach (SUVmax = 24.3) (D).
jkes-23-50-g001
Fig. 2
Thyroid USG shows 1 cm hyperechogenic nodule in right lobe. White arrows indicate a thyroid nodule (A). Fusion whole body PET shows hypermetabolic lesion in right lobe thyroid (SUVmax = 4.6).
jkes-23-50-g002
Fig. 3
Microscopic finding obtained from thyroid FNA. The high cellularity of follicle cells and the scanty amount of colloid are favorable cytological features of follicular neoplasm (A, HE stain, ×400). The tumor cells are weakly positive on galectin-3 immunostaining, favoring follicular carcinoma (B, galectin-3 stain, ×400 ).
jkes-23-50-g003
Fig. 4
Histological finding obtained liver. Immunohistochemical stainings for thyroglobulin revealed metastatic follicular thyroid carcinoma (thyroglobulin stain ×400).
jkes-23-50-g004

References

1. Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am. 1995. 24:761–801.
2. Shaha AR, Shah JP, Loree TR. Patterns of nodal and distinct metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg. 1996. 172:692–694.
3. Brennan MD, Bergstralh EJ, van Heerden JA, McConahey WM. Follicular thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy and outcome. Mayo Clin Proc. 1991. 66:11–19.
4. DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990. 71:414–424.
5. van Heerden JA, Hay ID, Goellner JR, Salomao D, Ebersold JR, Berqstralh EJ, Grant CS. Follicular thyroid carcinoma with capsular invasion alone: a nonthreatening malignancy. Surgery. 1992. 112:1130–1138.
6. Shoup M, Stojadinovic A, Nissan A, Ghossein RA, Freedman S, Brennan MF, Shah JP, Shaha AR. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. J AM Coll Surg. 2003. 197:191–197.
7. Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer. 2005. 103:2269–2273.
8. Sclabas GM, Staerkel GA, Shapiro SE, Fornage BD, Sherman SI, Vassillopoulou-Sellin R, Lee JE, Evans DB. Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients. Am J Surg. 2003. 186:702–709.
9. Cvejic D, Savin S, Paunovic I, Tatic S, Havelka M, Sinadinovic J. Immunohistochemical localization of galectin-3 in malignant and benign human thyroid tissue. Anticancer Res. 1998. 18:2637–2641.
10. Saggiorato E, Aversa S, Deandreis D, Arecco F, Mussa A, Puligheddu B, Cappia S, Conticello S, Papotti M, Orlandi F. Galectin-3: presurgical marker of thyroid follicular epithelial cell-derived carcinomas. J Endocrinol Invest. 2004. 27:311–317.
11. Lind P, Kumnig G, Matschnig S, Heinisch M, Gallowitsch HJ, Mikosch P, Kresnik E, Gomez I, Unterweger O. The role of F-18FDG PET in thyroid cancer. Acta Med Austriaca. 2000. 27:38–41.
12. Bingle CD. Thyroid Transcription Factor-1. Int J Biochem Cell Biol. 1997. 29:1471–1473.
TOOLS
Similar articles