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Metastasis of colon cancer to medullary thyroid carcinoma: a case report.

Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, Kim CH, Kang SK, Mok JO - J. Korean Med. Sci. (2014)

Bottom Line: He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery.Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC).To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

ABSTRACT
Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.

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PET scan and Ultrasound finding. (A) PET scan shows focal hypermetabolism in the right lobe of thyroid gland (SUV 2.5). (B) Ultrasonography shows marked hypoechoic solid nodule with lobulated margin with inner microcalcification, measured 1.6×1.0×2.5 cm (2.42 cm3), in right mid pole.
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Figure 1: PET scan and Ultrasound finding. (A) PET scan shows focal hypermetabolism in the right lobe of thyroid gland (SUV 2.5). (B) Ultrasonography shows marked hypoechoic solid nodule with lobulated margin with inner microcalcification, measured 1.6×1.0×2.5 cm (2.42 cm3), in right mid pole.

Mentions: A 53-yr old man underwent an anterior resection of his cancerous sigmoid colon and adjuvant chemotherapy on November 14, 2005. About one year after surgery, a fluorine-18-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (18F-FDG PET/CT) scan showed focal hypermetabolism in the right lobe of the thyroid gland (standardized uptake value, [SUV] 4) and pulmonary nodules in the right lung, suggesting hematogenous metastatic lesions. He received chemotherapy as palliative treatment. Two years later, a PET scan still revealed a nodule, showing focal activity in the thyroid gland (SUV 2.5) (Fig. 1A). A thyroid gland ultrasonography showed a marked hypoechoic solid nodule with a lobulated margin and inner microcalcification in the right mid pole, suggesting malignancy (Fig. 1B). The patient underwent ultrasound-guided fine needle aspiration biopsy (FNAB) of the thyroid nodule. FNAB showed tumor cell clusters, which were suspected to be MTC. Serum calcitonin and carcinoembryonic antigen (CEA) levels were mildly elevated (17.3 pg/mL (reference range: 0-10 pg/mL) for calcitonin; 29.31 ng/mL (reference range: 0-4.7 ng/mL) for CEA. Thyroid stimulating hormone was 2.47 µIU/mL (0.25-4.0 µIU/mL), thyroglobulin antigens were 9.96 ng/mL (0-35 ng/mL), antithyroglobulin antibodies were 0.19 IU/mL 0-0.3 IU/mL). The serum level of intact parathyroid hormone was 40.83 pg/mL (15-65 pg/mL). The 24-hr urine cortisol/metanephrine/cathecholamin levels were within the normal range. Rearranged during transfection (RET) proto-oncogene mutations were not detected. Subsequently, the patient underwent a total thyroidectomy and bilateral central neck dissection.


Metastasis of colon cancer to medullary thyroid carcinoma: a case report.

Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, Kim CH, Kang SK, Mok JO - J. Korean Med. Sci. (2014)

PET scan and Ultrasound finding. (A) PET scan shows focal hypermetabolism in the right lobe of thyroid gland (SUV 2.5). (B) Ultrasonography shows marked hypoechoic solid nodule with lobulated margin with inner microcalcification, measured 1.6×1.0×2.5 cm (2.42 cm3), in right mid pole.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214946&req=5

Figure 1: PET scan and Ultrasound finding. (A) PET scan shows focal hypermetabolism in the right lobe of thyroid gland (SUV 2.5). (B) Ultrasonography shows marked hypoechoic solid nodule with lobulated margin with inner microcalcification, measured 1.6×1.0×2.5 cm (2.42 cm3), in right mid pole.
Mentions: A 53-yr old man underwent an anterior resection of his cancerous sigmoid colon and adjuvant chemotherapy on November 14, 2005. About one year after surgery, a fluorine-18-fluorodeoxyglucose-positron emission tomography integrated with computed tomography (18F-FDG PET/CT) scan showed focal hypermetabolism in the right lobe of the thyroid gland (standardized uptake value, [SUV] 4) and pulmonary nodules in the right lung, suggesting hematogenous metastatic lesions. He received chemotherapy as palliative treatment. Two years later, a PET scan still revealed a nodule, showing focal activity in the thyroid gland (SUV 2.5) (Fig. 1A). A thyroid gland ultrasonography showed a marked hypoechoic solid nodule with a lobulated margin and inner microcalcification in the right mid pole, suggesting malignancy (Fig. 1B). The patient underwent ultrasound-guided fine needle aspiration biopsy (FNAB) of the thyroid nodule. FNAB showed tumor cell clusters, which were suspected to be MTC. Serum calcitonin and carcinoembryonic antigen (CEA) levels were mildly elevated (17.3 pg/mL (reference range: 0-10 pg/mL) for calcitonin; 29.31 ng/mL (reference range: 0-4.7 ng/mL) for CEA. Thyroid stimulating hormone was 2.47 µIU/mL (0.25-4.0 µIU/mL), thyroglobulin antigens were 9.96 ng/mL (0-35 ng/mL), antithyroglobulin antibodies were 0.19 IU/mL 0-0.3 IU/mL). The serum level of intact parathyroid hormone was 40.83 pg/mL (15-65 pg/mL). The 24-hr urine cortisol/metanephrine/cathecholamin levels were within the normal range. Rearranged during transfection (RET) proto-oncogene mutations were not detected. Subsequently, the patient underwent a total thyroidectomy and bilateral central neck dissection.

Bottom Line: He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery.Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC).To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

ABSTRACT
Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.

Show MeSH
Related in: MedlinePlus