Zhang Xing, Gu Xin, Li Jia-Gen, Hu Xian-Jie
Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China.
Department of Pathology, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China.
World J Clin Cases. 2020 Oct 6;8(19):4588-4594. doi: 10.12998/wjcc.v8.i19.4588.
Esophageal cancer is one of the most common causes of cancer-related death. Some patients with esophageal cancer have distant metastases at the time of diagnosis, but metastasis to the thyroid gland (MTG) and multifocal thyroid lesions alone are extremely rare.
In this case report, we present a case of a 69-year-old male with esophageal MTG. The patient visited our hospital for a routine body check-up, which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes. A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes. The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes, and a total thyroidectomy was performed. The histology showed MTG and therefore, a diagnostic work-up was implemented to determine the primary tumor. A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck, chest, and abdomen were involved. An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma. The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.
This case report highlights the difficulty in diagnosing esophageal MTG. Patients may have no malignancy history and be asymptomatic. Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology, and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.
食管癌是癌症相关死亡的最常见原因之一。一些食管癌患者在诊断时已有远处转移，但单独转移至甲状腺（MTG）及多灶性甲状腺病变极为罕见。
在本病例报告中，我们呈现了一例69岁男性食管MTG患者。该患者因常规体检就诊我院，检查发现其甲状腺叶内有多灶性结节及颈部淋巴结肿大。细针穿刺活检显示甲状腺病变及淋巴结均为恶性。患者最初被诊断为原发性双侧甲状腺癌伴淋巴结转移，遂行甲状腺全切术。组织学检查显示为MTG，因此开展了诊断性检查以确定原发肿瘤。氟-18-脱氧葡萄糖正电子发射断层扫描显示食管下段及颈部、胸部和腹部淋巴结受累。食管胃镜检查及相应病理显示为远端食管鳞状细胞癌。经病理免疫组化确诊为食管MTG。
本病例报告凸显了食管MTG诊断的困难。患者可能无恶性肿瘤病史且无症状。经细胞学或组织学确诊MTG后，需进一步进行诊断性检查，最终诊断应根据原发恶性肿瘤的鉴定结果及病理免疫组化结果作出。
