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Thyroid metastasis from small cell lung carcinoma: a case report and review of the literature.

Can AS, Köksal G - J Med Case Rep (2015)

Bottom Line: A 55-year-old Turkish man presented with a mediastinal mass intermingled with mediastinal lymphadenopathy, measuring 11cm in total, and encasing superior vena cava and deviating his trachea, esophagus and vascular structures.He had superior vena cava syndrome.The clinical features of our and two previously reported cases were summarized.

View Article: PubMed Central - PubMed

Affiliation: Termal Vocational School, Yalova University, Gökçedere Mahallesi, Kışla Caddesi, Nergis Sokak, No: 23, Termal, Yalova, 77200, Turkey. selcukcan@endokrinoloji.com.

ABSTRACT

Introduction: Small cell lung carcinoma frequently metastasizes to lymph nodes, liver, adrenal glands, bone, brain and pleura. Metastasis of small cell lung cancer to the thyroid gland is extremely rare.

Case presentation: A 55-year-old Turkish man presented with a mediastinal mass intermingled with mediastinal lymphadenopathy, measuring 11cm in total, and encasing superior vena cava and deviating his trachea, esophagus and vascular structures. He had superior vena cava syndrome. His thyroid appeared normal on computed tomography of his chest. A bronchoscopic biopsy showed small cell lung carcinoma. Chemotherapy with cisplatin and etoposide and external radiotherapy was given. Six months after the presentation, multiple brain metastases were detected on magnetic resonance imaging. Chemotherapy was changed to topotecan and cranial irradiation was performed. At the same time, a right thyroid nodule was detected on computed tomography of his chest and showed growth in size in the following 4 months. A palpable right thyroid nodule came to our attention at that time, the 10th month of presentation. Free thyroxine, free triiodothyronine, thyroid-stimulating hormone, antithyroglobulin and antithyroid peroxidase antibodies were within normal limits. Thyroid ultrasonography showed a right thyroid lobe 26.2×16.8×15.7mm hypoechoic solid nodule with irregular borders. Ultrasonography-guided thyroid fine-needle aspiration biopsy showed metastasis from small cell lung carcinoma. His cranial metastases worsened. He developed right cervical lymph node, hepatic, pancreatic and meningeal metastases and died 15 months after the initial presentation and 9 months after the detection of thyroid metastasis by computed tomography of his chest. Our case and two previously reported cases were male, 55-years old or older and had history of more than 40 pack-years of cigarette smoking. All had metastatic disease elsewhere, when the thyroid metastasis was diagnosed by fine-needle aspiration biopsy. All had poor survival, between 9 and 18 months, after thyroid metastasis was diagnosed.

Conclusions: We conclude that in a patient with a known history of malignant disease, the finding of a new thyroid mass should be promptly evaluated with a thyroid fine-needle aspiration biopsy to search for metastatic disease. The clinical features of our and two previously reported cases were summarized.

No MeSH data available.


Related in: MedlinePlus

Computed tomography image of subcarinal lymphadenopathy
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Fig2: Computed tomography image of subcarinal lymphadenopathy

Mentions: A 55-year-old Turkish man presented with swelling in the anterior of his neck and dyspnea for 3 to 4 days. His past medical history was significant for hypertension, hyperlipidemia and a hip prosthesis. He was treated with atenolol, quinapril-hydrochlorothiazide combination and atorvastatin tablets. He had a 50-pack year history of cigarette smoking. His blood pressure was 140/88mmHg, pulse 96 beats per minute and respiratory rate 16 per minute. A chest X-ray showed a mediastinal mass. Computed tomography (CT) of his thorax showed a 10.6×9.7×10.8cm mediastinal mass encasing superior vena cava, causing stenosis of the lumen and deviation of his trachea, esophagus and vascular structures. The mass also reached to the right pulmonary hilus. The presence of lymph node metastasis was not clearly discernible from the images, because the mass appeared somewhat homogeneous (Fig. 1). Subcarinal lymphadenopathy was evident (Fig. 2). In retrospect, we think that the mass was intermingled with multiple lymph node metastases, because they regressed with chemotherapy and radiotherapy. The thyroid appeared normal on CT of his chest. He exhibited clinical features of superior vena cava syndrome. The staging was done by CT of his chest and abdomen. Positron emission tomography-CT and endobronchial ultrasound were not performed. There was no evidence of liver or pancreatic metastases on the initial CT of his abdomen. He had a 15mm hypodense nodule in his left adrenal gland that was not biopsied and remained stable in size during follow-up. A bronchoscopic biopsy showed small cell carcinoma of the lung (Fig. 3). Immunohistochemical staining with synaptophysin, pan cytokeratin and chromogranin (Fig. 4) were positive. A diagnosis of limited stage small cell lung carcinoma was made and he was started on chemotherapy with cisplatin and etoposide. When his tumor diminished in size and fitted to the radiotherapy field, external radiotherapy was instituted. The clinical course showed refractoriness to treatment. He developed radiation pneumonitis and later fibrosis in his right lung. Six months after the presentation, a right thyroid nodule was detected on CT of his chest and multiple brain metastases were detected on magnetic resonance imaging of his brain. Chemotherapy was changed to topotecan. Cranial irradiation was given. He developed pancytopenia. Ten months after the presentation, the patient’s oncologist (second author Gülistan Köksal, MD) was alerted by the finding of the size progression of the right thyroid nodule on a CT scan of the patient’s chest (Fig. 5). On physical examination, a right thyroid nodule was palpable. Thyroid function tests were within normal limits at that time, as well as antithyroglobulin and antithyroid peroxidase antibodies, which were performed at a later date. Tests revealed: free thyroxine (T4) 1.32ng/ml (normal range 0.8 to 1.81), free triiodothyronine (T3) 2.35pg/ml (normal range 2.30 to 4.40), thyroid-stimulating hormone 0.313μIU/ml (normal range 0.27 to 4.20), antithyroid peroxidase antibody 1.1IU/ml (normal range <12), and antithyroglobulin antibody 5.9IU/ml (normal range <34). Thyroid ultrasonography showed a 26.2×16.8×15.7mm hypoechoic solid nodule with irregular borders in his right thyroid lobe (Fig. 6). An ultrasonography-guided thyroid fine-needle aspiration biopsy showed metastasis from small cell lung carcinoma (Fig. 7). His cranial metastases worsened. There was no size reduction of the initially detected metastatic thyroid nodule and two new hypoechoic nodules of 4.2×4.7×2.5mm and 4.2×3.4×3.4mm with blurred borders were detected by thyroid ultrasonography performed 4.5 months after the diagnosis of the thyroid metastasis by fine-needle aspiration biopsy. He developed right cervical lymph node, hepatic, pancreatic and meningeal metastases and expired 15 months after the initial presentation and 9 months after the detection of thyroid metastasis on CT of his chest.Fig. 1


Thyroid metastasis from small cell lung carcinoma: a case report and review of the literature.

Can AS, Köksal G - J Med Case Rep (2015)

Computed tomography image of subcarinal lymphadenopathy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597458&req=5

Fig2: Computed tomography image of subcarinal lymphadenopathy
Mentions: A 55-year-old Turkish man presented with swelling in the anterior of his neck and dyspnea for 3 to 4 days. His past medical history was significant for hypertension, hyperlipidemia and a hip prosthesis. He was treated with atenolol, quinapril-hydrochlorothiazide combination and atorvastatin tablets. He had a 50-pack year history of cigarette smoking. His blood pressure was 140/88mmHg, pulse 96 beats per minute and respiratory rate 16 per minute. A chest X-ray showed a mediastinal mass. Computed tomography (CT) of his thorax showed a 10.6×9.7×10.8cm mediastinal mass encasing superior vena cava, causing stenosis of the lumen and deviation of his trachea, esophagus and vascular structures. The mass also reached to the right pulmonary hilus. The presence of lymph node metastasis was not clearly discernible from the images, because the mass appeared somewhat homogeneous (Fig. 1). Subcarinal lymphadenopathy was evident (Fig. 2). In retrospect, we think that the mass was intermingled with multiple lymph node metastases, because they regressed with chemotherapy and radiotherapy. The thyroid appeared normal on CT of his chest. He exhibited clinical features of superior vena cava syndrome. The staging was done by CT of his chest and abdomen. Positron emission tomography-CT and endobronchial ultrasound were not performed. There was no evidence of liver or pancreatic metastases on the initial CT of his abdomen. He had a 15mm hypodense nodule in his left adrenal gland that was not biopsied and remained stable in size during follow-up. A bronchoscopic biopsy showed small cell carcinoma of the lung (Fig. 3). Immunohistochemical staining with synaptophysin, pan cytokeratin and chromogranin (Fig. 4) were positive. A diagnosis of limited stage small cell lung carcinoma was made and he was started on chemotherapy with cisplatin and etoposide. When his tumor diminished in size and fitted to the radiotherapy field, external radiotherapy was instituted. The clinical course showed refractoriness to treatment. He developed radiation pneumonitis and later fibrosis in his right lung. Six months after the presentation, a right thyroid nodule was detected on CT of his chest and multiple brain metastases were detected on magnetic resonance imaging of his brain. Chemotherapy was changed to topotecan. Cranial irradiation was given. He developed pancytopenia. Ten months after the presentation, the patient’s oncologist (second author Gülistan Köksal, MD) was alerted by the finding of the size progression of the right thyroid nodule on a CT scan of the patient’s chest (Fig. 5). On physical examination, a right thyroid nodule was palpable. Thyroid function tests were within normal limits at that time, as well as antithyroglobulin and antithyroid peroxidase antibodies, which were performed at a later date. Tests revealed: free thyroxine (T4) 1.32ng/ml (normal range 0.8 to 1.81), free triiodothyronine (T3) 2.35pg/ml (normal range 2.30 to 4.40), thyroid-stimulating hormone 0.313μIU/ml (normal range 0.27 to 4.20), antithyroid peroxidase antibody 1.1IU/ml (normal range <12), and antithyroglobulin antibody 5.9IU/ml (normal range <34). Thyroid ultrasonography showed a 26.2×16.8×15.7mm hypoechoic solid nodule with irregular borders in his right thyroid lobe (Fig. 6). An ultrasonography-guided thyroid fine-needle aspiration biopsy showed metastasis from small cell lung carcinoma (Fig. 7). His cranial metastases worsened. There was no size reduction of the initially detected metastatic thyroid nodule and two new hypoechoic nodules of 4.2×4.7×2.5mm and 4.2×3.4×3.4mm with blurred borders were detected by thyroid ultrasonography performed 4.5 months after the diagnosis of the thyroid metastasis by fine-needle aspiration biopsy. He developed right cervical lymph node, hepatic, pancreatic and meningeal metastases and expired 15 months after the initial presentation and 9 months after the detection of thyroid metastasis on CT of his chest.Fig. 1

Bottom Line: A 55-year-old Turkish man presented with a mediastinal mass intermingled with mediastinal lymphadenopathy, measuring 11cm in total, and encasing superior vena cava and deviating his trachea, esophagus and vascular structures.He had superior vena cava syndrome.The clinical features of our and two previously reported cases were summarized.

View Article: PubMed Central - PubMed

Affiliation: Termal Vocational School, Yalova University, Gökçedere Mahallesi, Kışla Caddesi, Nergis Sokak, No: 23, Termal, Yalova, 77200, Turkey. selcukcan@endokrinoloji.com.

ABSTRACT

Introduction: Small cell lung carcinoma frequently metastasizes to lymph nodes, liver, adrenal glands, bone, brain and pleura. Metastasis of small cell lung cancer to the thyroid gland is extremely rare.

Case presentation: A 55-year-old Turkish man presented with a mediastinal mass intermingled with mediastinal lymphadenopathy, measuring 11cm in total, and encasing superior vena cava and deviating his trachea, esophagus and vascular structures. He had superior vena cava syndrome. His thyroid appeared normal on computed tomography of his chest. A bronchoscopic biopsy showed small cell lung carcinoma. Chemotherapy with cisplatin and etoposide and external radiotherapy was given. Six months after the presentation, multiple brain metastases were detected on magnetic resonance imaging. Chemotherapy was changed to topotecan and cranial irradiation was performed. At the same time, a right thyroid nodule was detected on computed tomography of his chest and showed growth in size in the following 4 months. A palpable right thyroid nodule came to our attention at that time, the 10th month of presentation. Free thyroxine, free triiodothyronine, thyroid-stimulating hormone, antithyroglobulin and antithyroid peroxidase antibodies were within normal limits. Thyroid ultrasonography showed a right thyroid lobe 26.2×16.8×15.7mm hypoechoic solid nodule with irregular borders. Ultrasonography-guided thyroid fine-needle aspiration biopsy showed metastasis from small cell lung carcinoma. His cranial metastases worsened. He developed right cervical lymph node, hepatic, pancreatic and meningeal metastases and died 15 months after the initial presentation and 9 months after the detection of thyroid metastasis by computed tomography of his chest. Our case and two previously reported cases were male, 55-years old or older and had history of more than 40 pack-years of cigarette smoking. All had metastatic disease elsewhere, when the thyroid metastasis was diagnosed by fine-needle aspiration biopsy. All had poor survival, between 9 and 18 months, after thyroid metastasis was diagnosed.

Conclusions: We conclude that in a patient with a known history of malignant disease, the finding of a new thyroid mass should be promptly evaluated with a thyroid fine-needle aspiration biopsy to search for metastatic disease. The clinical features of our and two previously reported cases were summarized.

No MeSH data available.


Related in: MedlinePlus