Bruglia M, Palmonella G, Silvetti F, Rutigliano P, Criante P, Marmorale C, Boscaro M, Taccaliti A
Division of Endocrinology, Department of Internal Medicine, Polytechnic University of Marche, Via Conca, Ancona 60020, Italy.
Singapore Med J. 2009 Feb;50(2):e61-4.
A 44-year-old man with total thyroidectomy for papillary thyroid carcinoma (PTC) performed at the age of 38 years was referred for mediastinal metastases demonstrated on chest radiograph and high serum thyroglobulin (Tg 328 ng/ml). Computed tomography revealed mediastinal lymph node enlargement with left bronchial compression and reduction of bronchial diameter, as well as two metastases in the left lung. Bronchoscopic biopsy findings showed a poorly-differentiated PTC, while a whole body scan after 131-Iodine therapy demonstrated uptake in the right subclavicular region. External beam radiotherapy and chemotherapy yielded no benefit; the neoplasm was aggressive, diffuse and experienced fast growth, leading to the formation of metastases also at unusual sites, such as the skin and thigh muscle. The patient died from a brain metastasis. We report a rare case of PTC metastasis with a poorly-differentiated component in a young patient. Rapid and diffuse metastases also to unusual sites led to death eight years after the initial diagnosis and treatment.
一名44岁男性，38岁时因乳头状甲状腺癌（PTC）接受了全甲状腺切除术，现因胸部X线片显示纵隔转移及血清甲状腺球蛋白水平升高（Tg 328 ng/ml）前来就诊。计算机断层扫描显示纵隔淋巴结肿大，压迫左支气管，导致支气管直径变窄，同时左肺有两处转移灶。支气管镜活检结果显示为低分化PTC，而131碘治疗后的全身扫描显示右锁骨下区域有摄取。外照射放疗和化疗均未见疗效；肿瘤具有侵袭性、弥漫性且生长迅速，还导致在不寻常部位如皮肤和大腿肌肉形成转移灶。患者死于脑转移。我们报告了一例年轻患者发生的罕见的PTC转移病例，伴有低分化成分。在初次诊断和治疗八年后，迅速且弥漫地转移至不寻常部位导致了患者死亡。
