J Korean Endocr Soc.  2007 Feb;22(1):50-54. 10.3803/jkes.2007.22.1.50.

A Case of Thyroid Microcarcinoma with Multiple Metastases, Including Liver Metastasis

• Lee SJ
• Kim WG
• Kim HY
• Lee HG
• Kim TY
• Koh YS

• KMID: 2178242
• DOI: http://doi.org/10.3803/jkes.2007.22.1.50

Abstract

A 65-year-old woman presented with a dry cough and multiple various sized nodules in both lungs on chest X-ray. A CT scan showed a 9.5 cm sized hypervascular mass in the liver and a 5.5 cm sized intraabdominal mass. A percutaneous needle biopsy of one of the lung nodules revealed a metastatic follicular thyroid carcinoma. Therefore, thyroid ultrasonography was performed, which revealed a 1 cm sized nodule in the right thyroid lobe. Cytology, obtained by ultrasonography guided fine needle aspiration, revealed a follicular neoplasm. The tumor cells were weakly positive on galectin-3 immunostaining, which favored a follicular carcinoma. An ultrasonography guided biopsy of the liver and EUS (endoscopic ultrasonography)-guided biopsy of the intraabdominal mass revealed a metastatic follicular thyroid carcinoma in the liver and peritoneum. We report a very rare case of a follicular thyroid microcarcinoma, with multiple metastases to the lung, liver and peritoneum.

Keyword

Follicular thyroid carcinoma; Intra-abdominal metastasis; Lung metastasis

MeSH Terms

Adenocarcinoma, Follicular
Aged
Biopsy
Biopsy, Fine-Needle
Biopsy, Needle
Cough
Female
Galectin 3
Humans
Liver*
Lung
Neoplasm Metastasis*
Peritoneum
Thorax
Thyroid Gland*
Tomography, X-Ray Computed
Ultrasonography
Galectin 3

Figure

• 

  Fig. 1 Liver dynamic CT shows large hypervascular mass (diameter; 9.5 cm) in anterior segment of right liver. The mass has capsular enhancement and central necrosis (A). Fusion whole body PET shows hypermetabolic lesion in liver (SUVmax = 30.8) (B). CT shows mass (diameter-5.5 cm) with calcification between liver and stomach (C). Fusion whole body PET shows hypermetabolic lesion between liver and stomach (SUVmax = 24.3) (D).

• 

  Fig. 2 Thyroid USG shows 1 cm hyperechogenic nodule in right lobe. White arrows indicate a thyroid nodule (A). Fusion whole body PET shows hypermetabolic lesion in right lobe thyroid (SUVmax = 4.6).

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  Fig. 3 Microscopic finding obtained from thyroid FNA. The high cellularity of follicle cells and the scanty amount of colloid are favorable cytological features of follicular neoplasm (A, HE stain, ×400). The tumor cells are weakly positive on galectin-3 immunostaining, favoring follicular carcinoma (B, galectin-3 stain, ×400 ).

• 

  Fig. 4 Histological finding obtained liver. Immunohistochemical stainings for thyroglobulin revealed metastatic follicular thyroid carcinoma (thyroglobulin stain ×400).

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