SUN-489 MetastaticThyroidCancer

Abstract

Background In many cases, thyroid cancer leads to metastasis; however, isolated metastasis to the liver from thyroid cancer is a rare event. When this occurs, patients have a very poor prognosis. Case Study A clinical case of a 33-year-old woman, born in Piura and coming from Lima, with no major history, diagnosed with a 4-month-old cervical tumor is presented. An ultrasound scan and a further biopsy were performed before an eventual diagnosis of papillary thyroid carcinoma. Operation was performed, and a classical papillary carcinoma of 0.90 inches was detected, along with macro-metastasis in a parathyroid ganglion. Post-surgical thyroglobulin was 1071 ng/ml (n< 50 ng/ml). The tomography in her lung showed three nodules in the middle lobe. A further dose of 150 millicuries of radioactive iodine (I-131) was given, with whole-body scanning, post positive in both lung fields and right lank pain. The tomography in the abdomen revealed a hepatic pedicle injury, compatible with teratoma. A liver resection surgery was scheduled, and metastatic papillary carcinoma was identified. A V600 mutation in BRAF gene was present in thyroid gland and not detectable in the liver. Conclusions This case shows an example of thyroid cancer with uncommon metastasis in the liver, which occurs in 0.5% of all thyroid metastases. It is even rarer that positive iodine was found. Liver metastasis represents a poor prognosis, however it has been reported that resective surgery offers patients a better chance of survival. Multiple factors influence its pathogenesis, including BRAF mutations. In this case, mutation was detected in thyroid gland, but not in liver metastasis, which could represent diverse BRAF mutations.