Gheorghiu M L, Iorgulescu R, Vrabie C D, Tupea C C, Ursu H I
"C. I. Parhon" Institute of Endocrinology, Dept of Neuroendocrinology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"C. I. Parhon" Institute of Endocrinology, Dept. of Endocrinology, Bucharest, Romania.
Acta Endocrinol (Buchar). 2016 Jan-Mar;12(1):80-84. doi: 10.4183/aeb.2016.80.
The thyroid gland is one of the most vascularized organs in the body. However, metastatic disease to the thyroid gland is rare. When it does occur kidney is the most common primary tumor site, followed by melanoma, lung, breast, esophagus, uterus and colon carcinoma. We describe the case of an isolated thyroid metastasis from clear cell renal carcinoma occurring 16 years after nephrectomy. An 82 years-old woman presented for the recent growth of a right thyroid nodule, diagnosed 3 years before, when a fine needle aspiration biopsy found a benign cytology suggesting a well-differentiated follicular thyroid adenoma. Her medical history included type 2 diabetes mellitus, atrial fibrillation and a right nephrectomy for a clear cell renal carcinoma done 16 years before. The patient has lost weight but she was otherwise asymptomatic. The right lobe goiter was painless, firm, and mobile with deglutition, without signs of local compression or latero-cervical lymphadenopathy. Thyroid ultrasonography revealed an enlarged (9.9 cm) macronodular right lobe, with multiple cystic areas, with normal left lobe and a thrombus in the right internal jugular vein. Thyroid function tests were normal. The patient was suspected of thyroid carcinoma and underwent a near total thyroidectomy. Histopathological examination revealed a metastasis of clear cell renal carcinoma in the right thyroid gland lobe (8.5/5/5 cm). Further imaging showed no primary tumor or other metastases. Metastatic renal carcinoma to the thyroid should be considered in any patient presenting with a thyroid mass and a medical history of operated renal cell carcinoma, since it can occur up to 25 years after nephrectomy.
甲状腺是人体中血管分布最为丰富的器官之一。然而，甲状腺发生转移性疾病较为罕见。当这种情况确实发生时，肾脏是最常见的原发肿瘤部位，其次是黑色素瘤、肺癌、乳腺癌、食管癌、子宫癌和结肠癌。我们描述了一例在肾切除术后16年出现的孤立性甲状腺转移瘤，其原发灶为透明细胞肾细胞癌。一名82岁女性因右侧甲状腺结节近期增大前来就诊，该结节3年前被诊断出，当时细针穿刺活检显示良性细胞学结果，提示为分化良好的滤泡性甲状腺腺瘤。她的病史包括2型糖尿病、心房颤动以及16年前因透明细胞肾细胞癌接受的右侧肾切除术。患者体重减轻，但无其他症状。右侧叶甲状腺肿无痛、质地硬、随吞咽活动，无局部压迫迹象或颈侧淋巴结病。甲状腺超声检查显示右侧叶增大（9.9 cm），呈大结节状，有多个囊性区域，左侧叶正常，右侧颈内静脉有血栓。甲状腺功能检查正常。患者被怀疑患有甲状腺癌，遂接受了近全甲状腺切除术。组织病理学检查显示右侧甲状腺叶（8.5/5/5 cm）有透明细胞肾细胞癌转移灶。进一步影像学检查未发现原发肿瘤或其他转移灶。对于任何出现甲状腺肿块且有肾细胞癌手术病史的患者，都应考虑转移性肾细胞癌至甲状腺的可能性，因为这种情况可在肾切除术后长达25年发生。
