SUCCESSFUL PALLIATIVE CRYOABLATION AND RECANALIZATION OF INVASIVE FOLLICULAR THYROID CARCINOMA ENCROACHING INTO THE TRACHEA

Abstract

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Follicular Thyroid Carcinoma is a rare malignant tumor with an incidence of 5% of all thyroid carcinoma. Demographic profile for follicular thyroid carcinoma is male gender, age over 45 years, iodine deficiency and radiation exposure. Prognosis of follicular carcinoma are affected by tumor size, presence of distant metastases, age, gender, vascular invasion, and rare histologic type. While most thyroid carcinoma has good prognosis, tracheal invasion is an indicator of poor survival. Lesser invasive palliative procedures such as use of cryotherapy for recanalization and ablation are currently available that shortens hospital stay, reduces postsurgical complications, and improves quality of life. CASE PRESENTATION: A 24 year old female was referred to the Lung Center of the Philippines due to a tracheal mass noted on CT scan of the chest and neck which presented as hoarseness of voice and episodes of massive hemoptysis, started 8 months prior. Patient had poor recollection of a thyroid surgery from a surgical mission for enlarging neck mass 2 years preceding the referral. She noted of progressive exertional dyspnea and weight loss, yet denies fever and dysphagia. A repeat CT scan of the neck and chest showed a lobulated enhancing mass of about 2.3 x 2.6 cm at the right thyroidectomy bed encroaching into the trachea with 70% luminal narrowing. There were multiple non-calcified pulmonary nodules on both lungs. Patient underwent rigid bronchoscopic cryotherapy biopsy, ablation and recanalization of the tracheal mass by general anesthesia, total intravenous anesthesia via jet ventilation. On rigid bronchoscopy, there was noted a wide-base smooth mass attached to the anterior surface of the second and third tracheal ring, obstructing 70% the tracheal lumen. Frozen section of mass revealed atypical follicular cells favors thyroid carcinoma. Tracheal mass was signed out as invasive follicular thyroid carcinoma. Thyroid function test showed significant elevation of TSH at 31.927 IU/L, FT3 and T4 were within normal limits. Completion cryoablation was performed after a week. Patient was discharged stable, comfortable and non-oxygen requiring after 10 days of confinement. Patient underwent radioactive iodine treatment as outpatient. As of this writing, 10 months post cryotherapy, patient is still alive, up and about, no report of recurrence of hemoptysis, and non-dyspneic. DISCUSSION: Patient presented wilth metastic invasive follicular thyroid carcinoma. Palliative recanalization done for this patient has severed its purpose of relief of shortness of breath. Cryotherapy has been an adjunct to radioiodine therapy as palliative treatment. CONCLUSIONS: A 24 year old female with advanced invasive follicular thyroid carcinoma enchroaching to the tracheal lumen successfully underwent a palliative coring out and ablation of the tracheal mass using cryotherapy. Reference #1: Ito Y, Miyauchi A. Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid. Endocr J 2009; 56(2): 177–9. Reference #2: Filipović A, et al. Invasive Follicular thyroid carcinoma infiltrating the trachea.Vojnosanit Pregl 2011; 68(10): 891–894. DISCLOSURES: no disclosure on file for Joven Gonong; No relevant relationships by Portia Maria Tanyag, source=Web Response