Abstract
Non-small cell lung cancer (NSCLC) is the one of the leading causes of cancer deaths in Western population. Chemotherapy with platinum-based regimens is the first line management for majority of advanced NSCLC. Distant metastasis in lung cancer commonly involves the adrenal glands, liver, bones and brain. Metastatic involvement of the thyroid gland is infrequent despite its rich vascular supply. Here, we report a case of thyroid metastasis of NSCLC as a primary which was treated by thyroidectomy which is not the conventional approach. A 71 year-old female with a solitary left lower lobe lung mass was diagnosed with invasive poorly-differentiated adenocarcinoma. She was treated with cisplatin and pemetrexed followed by video-assisted thoracoscopic left lower lobectomy. The resected mass showed poorly-differentiated adenocarcinoma and was staged as pT2bN0 (Stage IIA). On a surveillance Computed Tomography (CT) chest, a left thyroid nodule was noted with findings consistent with Hashimoto's thyroiditis in a multinodular goiter. Fine-needle aspiration biopsy was consistent with metastasis from lung primary. This represented a solitary site of metastasis based on positron emission tomography (PET) Scan. Metastatic involvement of thyroid gland is infrequent despite its rich vascular supply. Given the long disease-free interval (DFI) of 1.5 years from initial diagnosis to documentation of isolated thyroid metastasis, she underwent total thyroidectomy followed by platinum-based adjuvant chemotherapy. Patient continues to be disease-free for more than 3 years as of her last follow up. A greater than 3-year disease-free survival to date in this case demonstrates that thyroidectomy can be a successful approach in the management of isolated metachronous thyroid metastasis from NSCLC in the well-selected patient.
Highlights
Metastatic involvement of the thyroid gland is infrequent despite its rich vascular supply [1,2]
We present a case where the patient presented with an isolated thyroid metastasis two years after resection of the primary lung tumor and was treated with thyroidectomy, an unconventional approach for the management of metastatic lung cancer given the isolated metachronous nature of the metastasis
Surgery as the primary approach of management was deemed to be feasible in our case because the patient presented with a solitary metachronous metastasis and several case series in the past have shown improved survival following solitary metastatectomy in similar presentation. This is a rare case of an isolated metachronous thyroid metastasis from lung adenocarcinoma treated with thyroidectomy and adjuvant chemotherapy leading to a good outcome
Summary
Metastatic involvement of the thyroid gland is infrequent despite its rich vascular supply [1,2]. We present a case where the patient presented with an isolated thyroid metastasis two years after resection of the primary lung tumor and was treated with thyroidectomy, an unconventional approach for the management of metastatic lung cancer given the isolated metachronous nature of the metastasis. A core needle biopsy diagnosed the presence of an invasive poorly-differentiated adenocarcinoma in a solitary pulmonary nodule located in the left lower lobe of the lung She received perioperative neoadjuvant chemotherapy with cisplatin and pemetrexed as part of a clinical trial and subsequently underwent videoscopic-assisted thoracoscopic (VATS) left lower lobectomy with lymph node dissection on 12/21/2008. Given the patient’s overall good health, the long disease-free interval (DFI) from her initial primary lung cancer diagnosis (1.5 years) and the isolated focus of metastasis, the patient underwent a total thyroidectomy in 09/2010.
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