Liang Hung-Hua, Wu Chih-Hsiung, Tam Ka-Wai, Chai Chiah-Yang, Lin Sey-En, Chen Soul-Chin
Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
World J Surg Oncol. 2007 Dec 24;5:144. doi: 10.1186/1477-7819-5-144.
Despite the apparent low incidence of cancer metastatic to the thyroid, autopsy and clinical series suggest it is more common than generally. Although lung, renal, and breast cancer are probably the most common primary sites, a number of cancers have been reported to metastasize to the thyroid synchronously with diagnosis of primary tumor or years after apparently curative treatment.
We report a rare case of a hepatocellular carcinoma metasatic to the thyroid. The patient presented seven months after original diagnosis and treatment with hepatic lobectomy with multiple neck lesions producing a mass effect on the trachea and bilateral lymphadenopathy. Fine-needle aspiration revealed highly anaplastic carcinoma, and immunohistochemistry confirmed hepatocellular carcinoma. The patient received total thyroidectomy as palliative therapy because of the presence of multiple recurrent lesions in the liver.
Clinicians should consider the possibility of metastatic cancer in each patient who presents with a new thyroid mass, especially those with a history of cancer, however remote. In cases where cytology or histology is not diagnostic, immunohistochemistry may be definitive in making the diagnosis.
尽管甲状腺癌转移的发病率看似较低，但尸检和临床系列研究表明其实际比普遍认为的更为常见。虽然肺癌、肾癌和乳腺癌可能是最常见的原发部位，但已有报道称，许多癌症在原发性肿瘤诊断时或在看似治愈性治疗数年之后会同步转移至甲状腺。
我们报告一例罕见的肝细胞癌转移至甲状腺的病例。患者在最初诊断并接受肝叶切除术后七个月出现，颈部有多个病变，对气管产生肿块效应并伴有双侧淋巴结病。细针穿刺显示为高度间变性癌，免疫组化证实为肝细胞癌。由于肝脏存在多个复发病变，患者接受了全甲状腺切除术作为姑息治疗。
临床医生应对每一位出现新的甲状腺肿块的患者，尤其是有癌症病史（无论多么久远）的患者，考虑转移性癌症的可能性。在细胞学或组织学诊断不明确的情况下，免疫组化可能对确诊具有决定性作用。
