Pulmonary Metastatic Follicular Thyroid Carcinoma Without Intrathyroidal Primary Thyroid Cancer

Q3 Medicine

AACE Clinical Case Reports Pub Date : 2024-07-01 DOI:10.1016/j.aace.2024.03.006

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

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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 (NRAS) 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.

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无甲状旁腺内原发性甲状腺癌的肺转移性滤泡状甲状腺癌

背景/目的没有甲状腺内原发癌的滤泡性甲状腺癌非常罕见。我们为您介绍一位患有多灶性肺转移滤泡性甲状腺癌的患者，她的甲状腺内无明显癌变。病例报告一位44岁的女性患者通过远程医疗转诊至甲状腺癌门诊，要求对肺内甲状腺组织进行评估。她的既往病史包括 Roux-en-Y 胃旁路术和双侧输卵管切除术。六个月前，腹部计算机断层扫描（CT）显示偶发双侧肺结节。胸部 CT 显示有 4 个左肺实性结节和 1 个右肺实性结节。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近厘米无回声结节。初次 CT 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，与氟脱氧葡萄糖相关的肺部病变面积分别为1.5、1.1和2.2厘米，还有其他几厘米以下的肺部结节。重复肺部核心活检显示甲状腺组织为微滤泡结构，倾向于神经母细胞瘤-RAS基因（NRAS）突变的转移性滤泡癌。全甲状腺切除术显示她患有多结节性增生，但未发现甲状腺癌。术后放射性碘扫描显示她有双侧碘嗜性肺结节，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检测不到。她接受了 261 mCi 的放射性碘治疗。14个月后，胸部CT显示肺部结节减少，血清甲状腺球蛋白水平为0.7 ng/mL。讨论约有2例无原发来源且无其他部位转移的多灶性肺泡状甲状腺癌病例被报道。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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