Karalis John D, Jia Liwei, Murvelashvili Natia, Vora Amy, Tessnow Alex, Dackiw Alan P B
Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
AACE Clin Case Rep. 2022 Jan 13;8(3):131-134. doi: 10.1016/j.aace.2022.01.002. eCollection 2022 May-Jun.
Distant metastases from papillary thyroid carcinoma (PTC) are relatively rare and may be associated with a poor prognosis. The adrenal gland is a highly unusual site of metastasis in the natural course of PTC. Herein, we describe a case of an incidentally detected metastatic solid variant of PTC in the adrenal gland of an asymptomatic patient as the initial presentation.
A 67-year-old male patient was evaluated for a 4.7-cm adrenal incidentaloma discovered during a workup for nephrolithiasis. Biochemical evaluation revealed a nonfunctioning adrenal mass. The patient underwent adrenalectomy, which revealed metastatic PTC. A subsequent thyroid ultrasound revealed an isthmic nodule. Fine needle aspiration of the nodule was cytologically suspicious for a follicular neoplasm, and gene expression analysis revealed an c.182A>G sequence variation. The patient subsequently underwent total thyroidectomy, which revealed a 1.2-cm solid variant of PTC in the thyroid isthmus. Postoperatively, the patient underwent radioactive iodine ablation.
Our case illustrates an exceedingly rare and challenging situation-a metastatic solid variant of PTC in the adrenal gland of a patient with no prior history of PTC. When confronted with a PTC in the adrenal gland in the absence of a previously identified primary tumor, our experience suggests that the next step in management should be total thyroidectomy followed by radioactive iodine ablation.
A solid variant of PTC is a rare cause of an incidentally detected adrenal lesion. Multidisciplinary care team coordination is essential for accurate diagnosis and treatment plan formulation.
甲状腺乳头状癌（PTC）的远处转移相对少见，且可能与预后不良相关。肾上腺是PTC自然病程中极不常见的转移部位。在此，我们描述一例无症状患者肾上腺意外发现转移性实性PTC作为首发表现的病例。
一名67岁男性患者因肾结石检查时发现一个4.7厘米的肾上腺偶发瘤而接受评估。生化检查显示为无功能肾上腺肿块。患者接受了肾上腺切除术，术后发现为转移性PTC。随后的甲状腺超声检查发现甲状腺峡部有一个结节。对该结节进行细针穿刺，细胞学检查怀疑为滤泡性肿瘤，基因表达分析显示存在c.182A>G序列变异。患者随后接受了甲状腺全切术，术中发现甲状腺峡部有一个1.2厘米的实性PTC。术后，患者接受了放射性碘消融治疗。
我们的病例说明了一种极其罕见且具有挑战性的情况——一名既往无PTC病史患者的肾上腺出现转移性实性PTC。当面对肾上腺出现PTC而此前未发现原发肿瘤时，我们的经验表明，下一步处理应是甲状腺全切术，随后进行放射性碘消融。
实性PTC是肾上腺偶发病变的罕见原因。多学科护理团队协作对于准确诊断和制定治疗方案至关重要。
