Abstract
Papillary thyroid carcinoma (PTC) commonly metastasizes to regional lymph nodes. However, they infrequently cause rare distant metastases (RDMs), with the exclusion of lungs and bone metastases. RDMs are seldom identified prior to a primary thyroid cancer diagnosis. Therefore, cases initially presenting with synchronously multiple RDMs from PTC are extremely infrequent. This is a rare case of a 48-year-old man with initial diaphragm, pancreatic, and liver tumors from PTC. Following resection of the tumors, an ultrasound-guided fine-needle aspiration (US-FNA) cytology of a mass in the thyroid's left lobe revealed PTC. After postoperative recovery for more than 4 months, physical examination identified an irregular large nodule in the thyroid's isthmus and left lobe, a swollen lymph node in the left neck, and a mass in the right parotid gland. Ultrasound reexamination revealed numerous hypoechoic masses as follows: one in the thyroid's isthmus and entire left lobe (7.3 × 5.9 × 5.1 cm) and multiple in the thyroid's right lobe (0.2–0.3 cm). Ultrasound examination also showed several swollen lymph nodes in the left neck, a mass in the left gluteus maximus, and several masses in both the bilateral parotid and salivary region. The US-FNA's pathological examination confirmed metastatic PTCs in the left gluteus maximus and bilaterally located in the parotid and salivary gland. 18-fluorodeoxyglucose positron-emission tomography and computed tomography scan revealed abnormal uptakes in numerous locations (e.g., the thyroid's isthmus and left lobe, bilateral parotid gland, subcutaneous tissues, etc.). The patient underwent palliative therapy, including total thyroidectomy, bilateral central neck dissection, left lateral neck dissection, and excision of the bilateral parotid and salivary gland. A whole-body scan post-therapeutic radioactive iodine ablation showed exclusive thyroid bed uptake. Subsequently, the patient underwent continuous thyroid stimulating hormone repression therapy and was treated with lenvatinib chemotherapy for ~8 months. The primary thyroid tumor, pancreatic metastasis, and cervical lymph node metastasis were both positive for BRAFV600E and TERT promoter (C288T) mutations. After 13 months of follow-up, the patient is currently in stable clinical conditions. In conclusion, the present case is an extremely rare occurrence of simultaneous multiple RDMs from PTC as the initial presentation.
Highlights
Thyroid cancer is the most common endocrine tumor, with an increasing incidence worldwide [1]
While papillary thyroid carcinoma (PTC) commonly metastasizes to regional lymph nodes [6, 7], distant metastases may sparsely occur
We report the case of a patient who presented initially with synchronously multiple organs rare distant metastases (RDMs) from a diagnosed primary PTC
Summary
Thyroid cancer is the most common endocrine tumor, with an increasing incidence worldwide [1]. A physical examination performed in our department following postoperative recovery showed an irregular large nodule in the isthmus and left lobe of the thyroid, a swollen lymph node in the left cervical lateral compartment, and a mass in the right parotid gland. The first revealed abnormal uptakes in the following locations: isthmus and left lobe of the thyroid, bilaterally in the parotid gland, left salivary gland, left cervical region, bilaterally in the lungs, pancreatic head, right kidney, and multiple cones, ribs, muscles and subcutaneous tissues (Figure 2). Results were consistent with PTC with multiple regional lymph nodes metastases and FIGURE 1 | Hematoxylin and eosin image showing that the pancreatic body (A: magnification, ×20; D: magnification, ×200), liver (B: magnification, ×20; E: magnification, ×200), and diaphragmatic (C: magnification, ×20; F: magnification, ×200) masses had a papillary architecture with folded nuclei with grooves, which is a characteristic of thyroid papillary carcinoma. We identified a TERT promoter mutation (C288T) by means of additional testing in the primary thyroid tumor, the pancreatic and cervical lymph node metastasis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
