Godbert Yann, Henriques-Figueiredo Benedicte, Cazeau Anne-Laure, Carrat Xavier, Stegen Marc, Soubeyran Isabelle, Bonichon Francoise
Department of Nuclear Medicine, Institut Bergonié, 229 Cours de L'Argonne, 33076 Bordeaux, France.
Case Rep Endocrinol. 2013;2013:719304. doi: 10.1155/2013/719304. Epub 2013 Feb 20.
Objectives. Thyroid carcinomas incidence, in particular papillary variants, is increasing. These cancers are generally considered to have excellent prognosis, and papillary microcarcinomas are usually noninvasive. Many prognostic histopathology factors have been described to guide therapeutic decisions. Most patients are treated with total thyroidectomy without radioiodine treatment or partial surgery. Case Summary. A 65-year-old man with no significant medical history presented with pain in the left chest wall that had been present for several months. A computed tomography (CT) found a large tissue mass of 4 cm responsible for lysis of the middle arch of the 4th rib on the left. It was a single lesion, highly hypermetabolic on the 18-FDG PET/CT. The histology analysis of the biopsy and surgical specimen favored an adenocarcinoma with immunostaining positive for TTF1 and thyroglobulin (Tg). The total thyroidectomy carried out subsequently revealed a 4 mm papillary microcarcinoma with vesicular architecture of the right lobe, well delimited and distant from the capsule without vascular embolisms. After two radioiodine treatments, the patient is in complete clinical, biological, and radiological remission. Conclusion. This extremely rare case of a singular bone metastasis revealing a papillary thyroid microcarcinoma illustrates the necessity of further research to better characterize the forms of papillary thyroid microcarcinomas with potentially poor prognosis.
目的。甲状腺癌的发病率，尤其是乳头状变体，正在上升。这些癌症通常被认为预后良好，乳头状微小癌通常无侵袭性。已经描述了许多预后组织病理学因素以指导治疗决策。大多数患者接受全甲状腺切除术，不进行放射性碘治疗或部分手术。病例摘要。一名65岁男性，无重大病史，出现左胸壁疼痛数月。计算机断层扫描（CT）发现一个4厘米的大组织肿块，导致左侧第4肋骨中弓溶解。这是一个单一病变，在18-FDG PET/CT上高度代谢活跃。活检和手术标本的组织学分析支持腺癌，免疫染色TTF1和甲状腺球蛋白（Tg）呈阳性。随后进行的全甲状腺切除术发现右叶有一个4毫米的乳头状微小癌，具有泡状结构，界限清楚，远离包膜，无血管栓塞。经过两次放射性碘治疗后，患者在临床、生物学和影像学上完全缓解。结论。这例极其罕见的以骨转移为首发表现的乳头状甲状腺微小癌病例说明了进一步研究以更好地表征预后可能较差的乳头状甲状腺微小癌形式的必要性。
