无甲状腺内原发性甲状腺癌的肺转移性滤泡状甲状腺癌

Pulmonary Metastatic Follicular Thyroid Carcinoma Without Intrathyroidal Primary Thyroid Cancer.

作者信息

Saberi Sima, Burris Nicholas, Wong Ka Kit, Brown Noah A, Giordano Thomas, Esfandiari Nazanene H

机构信息

Division of Metabolism Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.

Department of Radiology, University of Michigan, Ann Arbor, Michigan.

出版信息

AACE Clin Case Rep. 2024 Mar 26;10(4):123-126. doi: 10.1016/j.aace.2024.03.006. eCollection 2024 Jul-Aug.

DOI:10.1016/j.aace.2024.03.006

PMID:39100638

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11294749/

Abstract

BACKGROUND/OBJECTIVE: Follicular thyroid cancer without an intrathyroidal primary cancer is rare. We present a patient with multifocal pulmonary metastatic follicular thyroid cancer without apparent cancer within her thyroid.

CASE REPORT

A 44-year-old woman was referred to the thyroid cancer clinic via telemedicine for evaluation of intrapulmonary thyroid tissue. Her past medical history included Roux-en-Y gastric bypass and hysterectomy with bilateral oophorectomy. Six months prior, abdominal computed tomography (CT) showed incidental bilateral lung nodules. Chest CT demonstrated 4 solid left and 1 solid right lung nodules. Lung nodule core biopsy revealed benign thyroid tissue. Thyroid ultrasound showed bilateral subcentimeter anechoic nodules. Chest CT 6 months after initial CT demonstrated stable lung nodules. The levels of thyroid-stimulating hormone, serum thyroglobulin, and thyroglobulin antibody were 1.63 mIU/L (reference range, 0.3-5.5 mIU/L), 40.9 ng/mL (reference range, 0-35 ng/mL), and <1 IU/mL (reference range, <4), respectively. Positron emission tomography/CT showed fluorodeoxyglucose-avid lung lesions measuring 1.5, 1.1, and 2.2 cm and other subcentimeter pulmonary nodules. Repeat lung core biopsy showed thyroid tissue with microfollicular architecture, favoring metastatic follicular carcinoma with neuroblastoma-RAS gene () mutation. Total thyroidectomy performed showed multinodular hyperplasia without thyroid cancer. Her postoperative radioiodine scan demonstrated bilateral iodine-avid pulmonary nodules, a serum thyroglobulin level of 179.8 ng/mL, a thyroid-stimulating hormone level of 151.3 mIU/L, and undetectable serum thyroglobulin antibody. She received 261 mCi of radioactive iodine. Fourteen months later, chest CT revealed decreased lung nodules and a serum thyroglobulin level of 0.7 ng/mL.

DISCUSSION

Approximately 2 cases of multifocal pulmonary follicular thyroid cancer without a primary source and no other site of metastasis have been reported.

CONCLUSION

Pulmonary follicular thyroid cancer without a primary source and no other site of metastasis is extremely rare.

摘要

背景/目的：无甲状腺内原发癌的滤泡状甲状腺癌罕见。我们报告一例无明显甲状腺内癌灶的多灶性肺转移性滤泡状甲状腺癌患者。

病例报告

一名44岁女性通过远程医疗被转诊至甲状腺癌诊所，以评估肺内甲状腺组织。她既往有Roux-en-Y胃旁路手术史及子宫全切术加双侧卵巢切除术。6个月前，腹部计算机断层扫描（CT）显示双侧肺结节为偶然发现。胸部CT显示左肺有4个实性结节，右肺有1个实性结节。肺结节核心活检显示为良性甲状腺组织。甲状腺超声显示双侧小于1厘米的无回声结节。初次CT检查6个月后的胸部CT显示肺结节稳定。促甲状腺激素、血清甲状腺球蛋白和甲状腺球蛋白抗体水平分别为1.63 mIU/L（参考范围0.3 - 5.5 mIU/L）、40.9 ng/mL（参考范围0 - 35 ng/mL）和<1 IU/mL（参考范围<4）。正电子发射断层扫描/CT显示氟脱氧葡萄糖摄取阳性的肺部病灶，大小分别为1.5厘米、1.1厘米和2.2厘米，以及其他小于1厘米的肺结节。重复肺核心活检显示甲状腺组织呈微滤泡结构，倾向于伴有神经母细胞瘤-RAS基因（）突变的转移性滤泡癌。全甲状腺切除术显示为多结节性增生，无甲状腺癌。她术后的放射性碘扫描显示双侧碘摄取阳性的肺结节，血清甲状腺球蛋白水平为179.8 ng/mL，促甲状腺激素水平为151.3 mIU/L，血清甲状腺球蛋白抗体未检测到。她接受了261毫居里的放射性碘治疗。14个月后，胸部CT显示肺结节缩小，血清甲状腺球蛋白水平为0.7 ng/mL。