Vassilatou Evangeline, Fisfis Markos, Morphopoulos George, Savva Sotiria, Voucouti Eugenia, Stefanoudaki Katerine, Tzavara Ioanna
Department of Endocrinology, Diabetes and Metabolism, A. Fleming General Hospital, Athens, Greece.
Hormones (Athens). 2006 Oct-Dec;5(4):303-9. doi: 10.14310/horm.2002.11196.
Thyroid tumors producing colony-stimulating factors associated with neutrophilia and/or eosinophilia are very rare and almost all of them concern anaplastic thyroid cancer. Only one case of papillary thyroid carcinoma associated with neutrophilia and one case of medullary thyroid carcinoma associated with eosinophilia have been reported. In this report a 72-year old male patient with metastatic papillary thyroid carcinoma associated with neutrophilia and eosinophilia is described. While investigating the cause of neutrophilia and eosinophilia, a blind bone marrow biopsy of the posterior iliac crest was performed, which showed infiltration by papillary thyroid carcinoma. High blood levels of granulocyte-macrophage colony-stimulating factor (GM-csF) were found using an enzyme-linked immunosorbent assay. As other causes of neutrophilia and eosinophilia were excluded, we assumed that these were paraneoplastic manifestations induced by GM-csF produced by the thyroid tumor. the disease progressed rapidly, despite appropriate treatment which included thyroidectomy and postoperative radioactive (131)I administration. the patient died 11 months after diagnosis because of extensive lung metastasis. Neutrophilia and eosinophilia were stable findings, while serum thyroglobulin levels remained elevated throughout the follow-up period. to our knowledge, this is the first report of a patient with metastatic papillary thyroid carcinoma in whom neutrophilia and eosinophilia associated with high circulating levels of GM-csF were detected.
产生与嗜中性粒细胞增多和/或嗜酸性粒细胞增多相关的集落刺激因子的甲状腺肿瘤非常罕见，几乎所有此类肿瘤都与间变性甲状腺癌有关。仅报告过1例与嗜中性粒细胞增多相关的乳头状甲状腺癌病例和1例与嗜酸性粒细胞增多相关的髓样甲状腺癌病例。在本报告中，描述了1例患有转移性乳头状甲状腺癌且伴有嗜中性粒细胞增多和嗜酸性粒细胞增多的72岁男性患者。在调查嗜中性粒细胞增多和嗜酸性粒细胞增多的原因时，对髂后嵴进行了盲法骨髓活检，结果显示有乳头状甲状腺癌浸润。使用酶联免疫吸附测定法发现血液中粒细胞-巨噬细胞集落刺激因子（GM-csF）水平很高。由于排除了嗜中性粒细胞增多和嗜酸性粒细胞增多的其他原因，我们推测这些是由甲状腺肿瘤产生的GM-csF引起的副肿瘤表现。尽管进行了包括甲状腺切除术和术后放射性（131）I给药在内的适当治疗，疾病仍迅速进展。患者在诊断后11个月因广泛肺转移死亡。嗜中性粒细胞增多和嗜酸性粒细胞增多是稳定的表现，而血清甲状腺球蛋白水平在整个随访期间一直升高。据我们所知，这是首次报告1例转移性乳头状甲状腺癌患者，其检测到与循环中高水平GM-csF相关的嗜中性粒细胞增多和嗜酸性粒细胞增多。
