Djenic Brano, Duick Daniel, Newell James O, Demeure Michael J
General Surgery Resident, Maricopa Medical Center, Department of Surgery, Phoenix, AZ, USA.
Endocrinology Associates, Scottsdale, AZ, USA.
Int J Surg Case Rep. 2015;6C:146-9. doi: 10.1016/j.ijscr.2014.11.080. Epub 2014 Dec 12.
Papillary (PTC) and follicular (FTC) thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Sites of metastases from FTC are usually osseous and those from PTC are in regional nodal basins and the lungs. Visceral metastases are rare and when they do occur, they tend do so in multiple sites. We present the case of a patient with a follicular variant of PTC and a solitary metastasis to the liver then review the relevant literature.
An otherwise healthy 68-year-old woman was diagnosed with follicular variant papillary thyroid cancer in 2003 and subsequently underwent thyroidectomy. The patient's endocrinologist conducted surveillance of her thyroid cancer. In 2012, due to rise in thyroglobulin, a whole body radioiodine scan was obtained which revealed an iodine-avid left liver lobe mass. Three cycles of radioiodine ablation therapy were unsuccessful and eventually the patient was referred for surgical resection. Metastatic evaluation including a PET scan was negative with the exception of an isolated enhancing 4cm mass in segment 4B of the liver. Anatomic segmental resection of liver was performed without complications. Intraoperative ultrasonography was used to guide resection of the liver mass. Pathology reports confirmed metastatic follicular variant of PTC. Surgical margins were free of tumor. Patient was discharged home and is doing well one year after surgery. The latest thyroglobulin level was undetectable.
Post-operative surveillance by PCP, endocrinologist or surgeon for patients with thyroid carcinoma should be performed routinely. If identified, a solitary liver metastasis from primary thyroid carcinoma should be considered for surgical resection. Due to sparse data available in literature, collecting more data to establish algorithms for treatment of such rare metastatic cancers may be able to aid physicians to achieve better outcomes.
Rare distant sites of metastases from DTC include eyes, pharynx, skin, muscle, ovaries, adrenal glands, kidneys, esophagus, pancreas and liver. Isolated, resectable liver metastases from PTC are exceedingly rare. Literature review revealed only 10 reported cases of liver metastases from DTC. As in our patient, solitary liver metastasis from PTC should be considered for surgical resection which offers the best chance for prolonged survival.
乳头状（PTC）和滤泡状（FTC）甲状腺癌统称为分化型甲状腺癌（DTC），是最可治愈的癌症之一。FTC的转移部位通常在骨骼，而PTC的转移部位在区域淋巴结和肺部。内脏转移很少见，一旦发生，往往是多个部位同时出现。我们报告一例具有PTC滤泡状变异型且肝脏有孤立转移灶的患者，并回顾相关文献。
一名68岁身体健康的女性于2003年被诊断为滤泡状变异型乳头状甲状腺癌，随后接受了甲状腺切除术。患者的内分泌科医生对其甲状腺癌进行了监测。2012年，由于甲状腺球蛋白升高，进行了全身放射性碘扫描，结果显示左肝叶有一个摄取碘的肿块。三个周期的放射性碘消融治疗均未成功，最终患者被转诊进行手术切除。包括PET扫描在内的转移评估结果均为阴性，但肝脏4B段有一个孤立的4厘米强化肿块。进行了肝脏解剖性节段切除，未出现并发症。术中超声用于指导肝脏肿块的切除。病理报告证实为PTC滤泡状变异型转移。手术切缘无肿瘤。患者出院回家，术后一年情况良好。最新的甲状腺球蛋白水平检测不到。
初级保健医生、内分泌科医生或外科医生应对甲状腺癌患者进行术后常规监测。如果发现原发性甲状腺癌有孤立的肝转移，应考虑手术切除。由于文献中的数据稀少，收集更多数据以建立此类罕见转移性癌症的治疗算法可能有助于医生取得更好的治疗效果。
DTC罕见的远处转移部位包括眼睛、咽部、皮肤、肌肉、卵巢、肾上腺、肾脏、食管、胰腺和肝脏。PTC孤立的、可切除的肝转移极为罕见。文献回顾显示，仅有10例DTC肝转移的报告病例。如同我们的患者一样，PTC孤立的肝转移应考虑手术切除，这为延长生存期提供了最佳机会。
