Loureiro M M, Leite V H, Boavida J M, Raposo J F, Henriques M M, Limbert E S, Sobrinho L G
Serviço de Endocrinologia, Instituto Português de Oncologia, Lisboa, Portugal.
Eur J Endocrinol. 1997 Sep;137(3):267-9. doi: 10.1530/eje.0.1370267.
Cutaneous metastases of thyroid carcinoma are infrequent and, when present, are usually located in the vicinity of a widespread primary tumor. Breast metastases from these tumors are even less common. We report the case of a 64-year-old female with a toxic multinodular goiter in whom a fine-needle biopsy, performed in 1985 at the age of 52, was suggestive of papillary carcinoma of the thyroid. Total thyroidectomy for a papillary carcinoma, follicular variant, was performed in 1988. Four months after surgery, a cutaneous metastasis was discovered in the right thigh. Surgical excision of the lesion followed by treatment with radioactive iodine decreased serum Tg levels from 7495 to 3.3 micrograms/l. Under suppressive therapy with L-thyroxine, serum Tg remained undetectable for the next 4 years. Then, serum Tg levels rose to 3.9-5.6 micrograms/l and a second cutaneous metastasis was removed from the abdominal wall. The patient was again treated with radioactive iodine and the post-treatment whole-body scan did not show any area of increased uptake of the radionuclide. However, serum Tg levels under suppression with L-thyroxine remained elevated at 4-20 micrograms/l for the next 2 years. In August 1995, a 1.5 cm nodule was found in the right breast. Cytological examination was suggestive of a breast metastasis from thyroid carcinoma and the lesion was removed by enucleation. This proved to be a metastasis from a papillary carcinoma of the thyroid. Elevated (19-44 micrograms/l) serum Tg levels persisted postoperatively. A third cutaneous metastasis was revealed by 131I scintigraphy in the right buttock and surgically removed in December 1996. Serum Tg levels have remained undetectable since then. To the best of our knowledge, this is a unique case of a papillary carcinoma of the thyroid with a propensity to metastasize only to the skin and breast during a follow-up of 11 years.
甲状腺癌的皮肤转移并不常见，一旦出现，通常位于广泛存在的原发性肿瘤附近。这些肿瘤转移至乳腺则更为罕见。我们报告一例64岁女性，患有毒性多结节性甲状腺肿，1985年52岁时进行的细针穿刺活检提示甲状腺乳头状癌。1988年因甲状腺乳头状癌（滤泡状变异型）行全甲状腺切除术。术后四个月，在右大腿发现一处皮肤转移灶。手术切除病灶并给予放射性碘治疗后，血清甲状腺球蛋白（Tg）水平从7495降至3.3微克/升。在左甲状腺素抑制治疗下，接下来的4年血清Tg一直未检测到。然后，血清Tg水平升至3.9 - 5.6微克/升，并从腹壁切除了第二处皮肤转移灶。患者再次接受放射性碘治疗，治疗后的全身扫描未显示放射性核素摄取增加的区域。然而，在左甲状腺素抑制治疗下，接下来的2年血清Tg水平仍维持在4 - 20微克/升。1995年8月，右侧乳腺发现一个1.5厘米的结节。细胞学检查提示为甲状腺癌转移至乳腺，病灶通过剜除术切除。病理证实为甲状腺乳头状癌转移。术后血清Tg水平持续升高（19 - 44微克/升）。1996年12月，通过131I闪烁扫描在右臀部发现第三处皮肤转移灶并手术切除自此血清Tg水平一直未检测到。据我们所知这是一例独特的甲状腺乳头状癌病例，在11年的随访期间仅倾向于转移至皮肤和乳腺。
