Endocrinol Metab.  2011 Mar;26(1):78-83. 10.3803/EnM.2011.26.1.78.

Solitary Pulmonary Metastasis of a Thyroid Papillary Microcarcinoma, Masquerading as Primary Lung Cancer

• Lee JH
• Ahn SJ
• Kim HJ
• Jang SE
• Koh JS
• Lee YY
• Kim CH
• Lee JC

• KMID: 2169129
• DOI: http://doi.org/10.3803/EnM.2011.26.1.78

Abstract

Although pulmonary metastasis of thyroid cancer is not uncommon, it mostly occurs as multiple discrete nodules on the lung parenchyma. Because thyroid cancer presenting with an isolated large lung mass is extremely rare and the diagnosis is frequently based on small pieces of tissue obtained by a fine needle, the wrong diagnosis such as lung cancer is prone to be made. A 60-year-old man was admitted for evaluation of a lung mass detected on chest radiography. Cytological examination of the bronchial washing specimens suggested adenocarcinoma. Surgery for early lung cancer was performed considering that no other abnormalities were found during the work-up that included 18-fludeoxyglucose positron emission tomography computer tomography (18FDG-PET/CT). Unexpectedly, the diagnosis of papillary thyroid cancer with lung metastasis was made, which prompted us to evaluate the thyroid gland and then remove the primary cancer by subsequent operation. Although it is uncommon, physician should be aware of this possibility, which could help to avoid the wrong diagnosis. Here we report on a typical case of solitary pulmonary metastasis of thyroid cancer and we summarize the previously reported cases with a review of the relevant literature.

Keyword

Lung Neoplasm; Neoplasm Metastasis; Thyroid Cancer

MeSH Terms

Adenocarcinoma
Humans
Lung
Lung Neoplasms
Middle Aged
Needles
Neoplasm Metastasis
Positron-Emission Tomography
Thorax
Thyroid Gland
Thyroid Neoplasms

Figure

• 

  Fig. 1 Simple chest X-ray, CT and 18FDG-PET/CT findings. A. Chest radiograph showed a round mass behind cardiac shadow in left lower lobe (arrow). B. An about 2.9 cm-sized mass in the central portion of left lower lobe was found on chest CT. C. 18FDG-PET/CT revealed a hypermetabolic lesion with SUV of 4.5.

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  Fig. 2 Pathologic findings. A, B. Pathologic examination of the resected lung tumor showed typical tumor cells of papillary thyroid carcinoma (H&E staining; A, × 40) with nuclear groove (arrowhead) and intranuclear inclusions (arrow) (H&E staining; B, × 400). C. The immunohistological staining for thyroglobulin was strong-positive.

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  Fig. 3 Neck CT, 18FDG-PET/CT and ultrasound findings. A. 0.6 cm calcified nodule in left thyroid gland (arrow) and multiple small cysts and nodular hyperplasia in both thyroid glands were noted. B. There was no definite FDG uptake around the calcified nodule. C. An about 0.6 cm dense, round calcified nodule with posterior shadowing in left thyroid gland (arrow) and was found on thyroid ultrasonogram.

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