Endocrinol Metab.  2013 Mar;28(1):46-49. 10.3803/EnM.2013.28.1.46.

Long-Term Survival of a Patient with Pulmonary Artery Intimal Sarcoma after Sequential Metastasectomies of the Thyroid and Adrenal Glands

• Choi YM
• Jang EK
• Ahn SH
• Jeon MJ
• Han JM
• Kim SC
• Han DJ
• Gong G
• Kim TY
• Shong YK
• Kim WB

• KMID: 1805945
• DOI: http://doi.org/10.3803/EnM.2013.28.1.46

Abstract

Cancer metastases to the thyroid or adrenal gland are uncommon. Furthermore, cases showing long-term survival after surgical resection of those metastatic tumors are rare. We report a case of pulmonary artery intimal sarcoma with metastases to the thyroid and adrenal glands sequentially that was successfully treated with sequential metastasectomies. A 62-year-old woman presented with a 4-week history of dyspnea on exertion and facial edema in November 1999. Echocardiography and chest computed tomography (CT) revealed an embolism-like mass in the pulmonary trunk. Pulmonary artery endarterectomy with pulmonary valve replacement was performed, and histopathology revealed pulmonary artery intimal sarcoma. A thyroid nodule was found by chest CT in November 2001 (2 years after initial surgery). During follow-up, this lesion showed no change, but we decided to obtain fine needle aspiration cytology (FNAC) in August 2004 (4.7 years after initial surgery). FNAC revealed atypical spindle cells suggestive of metastatic intimal sarcoma. She underwent total thyroidectomy. During follow-up, a right adrenal gland mass was detected by chest CT in March 2006 (6.3 years after initial surgery), and adrenalectomy was done, which also revealed metastatic sarcoma. She has been followed up without any evidence of recurrent disease until May 2012 (12.5 years after initial surgery).

Keyword

Endocrine organ; Metastasectomy; Pulmonary artery intimal sarcoma

MeSH Terms

Adrenal Glands
Adrenalectomy
Biopsy, Fine-Needle
Dyspnea
Echocardiography
Edema
Endarterectomy
Female
Follow-Up Studies
Humans
Metastasectomy
Neoplasm Metastasis
Pulmonary Artery
Pulmonary Valve
Sarcoma
Thorax
Thyroid Gland
Thyroid Nodule
Thyroidectomy

Figure

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  Fig. 1 Chest computed tomography (CT) at initial diagnosis and final pathology after initial surgery. (A) Chest CT revealed an embolism-like mass in the pulmonary trunk (arrow). (B) Pathology showed the typical whorl formation pattern of sarcomas (H&E stain, ×400).

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  Fig. 2 Neck computed tomography (CT) and fine needle aspiration (FNA) smear results of the thyroid nodule. (A) Neck CT showed enlarged thyroid glands with a low density nodule in the left thyroid gland (2.0×2.5 cm) (arrow). (B) The FNA smear revealed atypical spindle cells, suggestive of metastatic intimal sarcoma (Papanicolaou stain, ×400).

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  Fig. 3 Chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) findings of the right adrenal gland. (A) Chest CT and (B) 18F-FDG PET showed a newly appeared 10.0×8.5 cm sized round heterogeneous mass above the right kidney (arrows).

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