Karrasch T, Doppl W, Roller F C, Schäffler A, Schäffer R, Gattenlöhner S
Department of Internal Medicine III, Giessen University Hospital, Klinikstrasse 33, 35392, Gießen, Germany.
Central Interdisciplinary Endoscopy Unit (ZIVE), Giessen University Hospital, 35392 Gießen, Germany.
J Med Case Rep. 2016 Jul 27;10:208. doi: 10.1186/s13256-016-0981-9.
Medullary thyroid carcinoma accounts for approximately 1 to 2 % of all thyroid carcinoma cases. The most common route of dissemination is to locoregional lymph nodes. Distant metastases commonly affect bones, lungs, and liver. We present a case of a white woman with a 25-year history of medullary thyroid carcinoma on multiple medications including tyrosine kinase inhibitor therapy for the last 11 months, who exhibited unusual diffuse infiltration of advanced stage medullary thyroid carcinoma to her gastric mucosa.
A 53-year-old white woman presented with increasing fatigue, loss of appetite, and severe epigastric pain radiating to her back. She had a history of medullary thyroid carcinoma (pT2pN1b), diagnosed 25 years ago and treated by complete thyroidectomy and repeated bilateral cervical lymph node dissection. Medical therapy included octreotide 20 mg every 4 weeks, which was switched to the tyrosine kinase inhibitor vandetanib 300 mg/day 11 months ago when computed tomography scanning revealed progressive mediastinal lymph node and diffuse and symptomatic pulmonary metastases. Of note, she demonstrated macroscopically stable pulmonary and mediastinal lymph node metastases; however, her calcitonin serum levels dramatically increased. Computed tomography scanning revealed a single new intrahepatic lesion (4 mm) as well as multiple (>10) new supraclavicular lesions suggestive of medullary thyroid carcinoma progress. As proven by gastric biopsy and immunohistochemical evaluation, her epigastric pain was explained by a diffuse infiltration of her gastric mucosa by metastatic medullary thyroid carcinoma. Subsequently, she rapidly deteriorated and died.
The current case report shows for the first time an unusual metastatic infiltration of the gastric mucosa by medullary thyroid carcinoma. When treating these patients, it is important to include this differential diagnosis during follow-up.
甲状腺髓样癌约占所有甲状腺癌病例的1%至2%。最常见的扩散途径是至局部区域淋巴结。远处转移通常累及骨骼、肺和肝脏。我们报告一例患有甲状腺髓样癌25年的白人女性病例，她在过去11个月中使用了多种药物，包括酪氨酸激酶抑制剂治疗，该患者表现出晚期甲状腺髓样癌对其胃黏膜的异常弥漫性浸润。
一名53岁白人女性因疲劳加重、食欲不振及严重的上腹部疼痛放射至背部就诊。她有甲状腺髓样癌（pT2pN1b）病史，25年前确诊，接受了全甲状腺切除术及多次双侧颈部淋巴结清扫术。药物治疗包括每4周使用20mg奥曲肽，11个月前当计算机断层扫描显示纵隔淋巴结进展及弥漫性且有症状的肺转移时，改为使用酪氨酸激酶抑制剂凡德他尼300mg/天。值得注意的是，她的肺部和纵隔淋巴结转移在宏观上保持稳定；然而，她的降钙素血清水平显著升高。计算机断层扫描显示肝脏有一个新的单一病灶（4mm）以及多个（>10个）新的锁骨上病灶，提示甲状腺髓样癌进展。经胃活检和免疫组化评估证实，她的上腹部疼痛是由转移性甲状腺髓样癌对胃黏膜的弥漫性浸润所致。随后，她病情迅速恶化并死亡。
本病例报告首次显示了甲状腺髓样癌对胃黏膜的异常转移浸润。在治疗这些患者时，随访期间纳入这种鉴别诊断很重要。
