Park Min Ho, Cho Jin Seong, Lee Ji Shin, Kim Hee Kyung, Yoon Jung Han
Department of Surgery, Chonnam National University College of Medicine, Gwangju, Republic of Korea.
Int J Surg Case Rep. 2012;3(2):78-81. doi: 10.1016/j.ijscr.2011.11.001. Epub 2011 Nov 15.
A primary cancer causing thyroid metastasis is extremely rare. In western countries, the most common primary tumors causing thyroid metastases include kidney, lung, breast, and gastrointestinal cancers. In contrast, breast is the most common primary site, followed by kidney, colon, and lung cancers in Korea. To the best of our knowledge, surgically confirmed thyroid metastasis from cholangiocarcinoma has not been reported. Herein, we report the first case of thyroid metastasis secondary to cholangiocarcinoma on which surgery was performed.
A 55-year-old man was diagnosed with hepatic malignancy in December 2008. He subsequently received 2 cycles of transarterial chemoembolization and 4 cycles of radio-frequency ablation between 2008 and 2010. At follow-up in January 2011, brain metastasis was identified in the right parietal area secondary to cholangiocarcinoma. In April 2011, the patient was found to have palpable masses on the left thyroid and lateral neck. The patient subsequently underwent total thyroidectomy followed by left radical neck dissection. Intraoperatively, an ill-defined mass measuring 6.0 cm was found infiltrating the subcutaneous tissue into the prevertebral fascia. Microscopic and immunohistochemical findings confirmed that the thyroid masses and lymph nodes were metastatic cholangiocarcinoma.
Positive immunohistochemical staining for cytokeratin 7, cytokeratin 19, and AFP and negative results for TG, TTF-1, and cytokeratin 20 can be definitely helpful in arriving at a correct diagnosis.
To the best of our knowledge, this is the first case report on surgically resected thyroid and lateral neck metastases secondary to cholangiocarcinoma.
导致甲状腺转移的原发性癌症极为罕见。在西方国家，引起甲状腺转移的最常见原发性肿瘤包括肾癌、肺癌、乳腺癌和胃肠道癌。相比之下，在韩国，乳腺癌是最常见的原发部位，其次是肾癌、结肠癌和肺癌。据我们所知，经手术证实的胆管癌甲状腺转移尚未见报道。在此，我们报告首例接受手术治疗的胆管癌继发甲状腺转移病例。
一名55岁男性于2008年12月被诊断为肝脏恶性肿瘤。随后在2008年至2010年间，他接受了2个周期的经动脉化疗栓塞和4个周期的射频消融治疗。在2011年1月的随访中，发现继发于胆管癌的右顶叶脑转移。2011年4月，患者左侧甲状腺及侧颈部可触及肿块。患者随后接受了甲状腺全切术及左侧根治性颈清扫术。术中发现一个边界不清、大小为6.0 cm的肿块，浸润皮下组织至椎前筋膜。显微镜检查和免疫组化结果证实甲状腺肿块及淋巴结为转移性胆管癌。
细胞角蛋白7、细胞角蛋白19和甲胎蛋白免疫组化染色阳性，而甲状腺球蛋白、甲状腺转录因子-1和细胞角蛋白20免疫组化染色阴性，这对明确诊断肯定有帮助。
据我们所知，这是首例关于手术切除胆管癌继发甲状腺及侧颈部转移的病例报告。
