Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, 221 85, Lund, Sweden.
J Med Case Rep. 2024 Sep 23;18(1):462. doi: 10.1186/s13256-024-04797-5.
Spontaneous hepatic hemorrhage is a rare condition, most commonly diagnosed in patients with hepatocellular carcinoma or hepatic adenomas, and is seldom caused by metastatic disease. In this case report, we present a patient with spontaneous hepatic hemorrhage due to hepatic metastasis of papillary thyroid carcinoma, an exceptionally rare occurrence.
The patient was a 77-year-old white male with a history of atrial fibrillation treated with apixaban. He presented at a local hospital with abdominal pain and nausea. A CT scan revealed a hepatic lesion in segment 3 with an adjacent hematoma. He was referred to our tertiary center and treated conservatively. Further evaluation revealed an intrathoracic goiter containing a tumorous process diagnosed as a papillary thyroid carcinoma (PTC), and the patient subsequently underwent thyroidectomy. A biopsy of the hepatic lesion confirmed it as a PTC metastasis. Due to worsening abdominal pain and anorexia, the patient underwent subacute hepatic segmental resection. Postoperatively, he developed iodine-refractory disease with disseminated metastasis and passed away 22 months after the initial admission.
To our knowledge, this is the first recorded case of metastasized papillary thyroid carcinoma presenting with spontaneous hepatic hemorrhage-adding to the list of rare causes for this condition.
自发性肝出血是一种罕见的病症，最常发生于肝细胞癌或肝腺瘤患者，很少由转移性疾病引起。在本病例报告中，我们报告了一例由甲状腺乳头状癌肝转移引起的自发性肝出血病例，这种情况极为罕见。
患者为 77 岁白人男性，有房颤病史，接受阿哌沙班治疗。他因腹痛和恶心在当地医院就诊。CT 扫描显示第 3 段肝脏有病灶，伴有相邻血肿。他被转至我们的三级中心接受保守治疗。进一步评估发现胸腔内甲状腺肿含有肿瘤性病变，诊断为甲状腺乳头状癌（PTC），随后患者接受了甲状腺切除术。肝脏病变活检证实为 PTC 转移。由于腹痛和食欲不振加重，患者接受了亚急性肝段切除术。术后，他发生了碘难治性疾病伴弥散性转移，在初次入院后 22 个月去世。
据我们所知，这是首例报道的转移性甲状腺乳头状癌表现为自发性肝出血的病例，增加了这种病症罕见病因的种类。
