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Lee, Kim, Kim, Lee, Kim, and Koh: A Case of Thyroid Microcarcinoma with Multiple Metastases, Including Liver Metastasis
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(1): 50-54.

Published online: 20 February 2007

DOI: https://doi.org/10.3803/jkes.2007.22.1.50

A Case of Thyroid Microcarcinoma with Multiple Metastases, Including Liver Metastasis

Sang Jin Lee, Won Gu Kim, Hyung Yong Kim, Hyun Gi Lee, Tae Yong Kim, Youn Suck Koh

Department of Internal Medicine, College of Medicine, Ulsan University, Seoul Asan Medical Center, Korea.

Received 18 August 2006       Accepted 23 October 2006

Copyright © 2007 Korean Endocrine Society

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)

Keywords: Follicular thyroid carcinoma, Intra-abdominal metastasis, Lung metastasis

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).
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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).
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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

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