Cholestatic syndrome as initial manifestation of pancreatic metastasis of papillary thyroid carcinoma: case report and review

Abstract

Most papillary thyroid carcinomas (PTC) harbor excellent prognosis. Although rare, distant metastases normally occur in lungs and/or bones. Here we describe a rare case of pancreatic metastasis presenting with rapid onset cholestatic syndrome. A literature review was also performed. A 73-yearold man with a high risk PTC was submitted to total thyroidectomy (TT) followed by radioiodine therapy. After initial therapy, he persisted with progressive rising serum thyroglobulin levels but with no evidence of structural disease. Recently, the patient presented with a rapid onset and progressive cholestatic syndrome. A 4 cm lesion in pancreas was identified, with echoendoscopy fine-needle aspiration biopsy (FNAB) confirming a pancreatic metastasis from PTC. The patient was submitted to a successful pancreaticoduodenectomy. Pancreatic metastases of PTC are rare and few long-term follow-up data are available to guide management. Fourteen cases were former reported, mean age was 65.7 years-old with mean time between PTC and pancreatic metastasis diagnosis of 7.9 years. Nine of them had another distant metastasis, nine were diagnosed by FNAB and just two received sorafenib. Arch Endocrinol Metab. 2020;64(2):179-84

Pancreatic metastasis from papillary thyroid cancer: a case report and literature review

“…Patients can be diagnosed with pancreatic metastasis from PTC at various ages (mean age, 59 years), and it occurs mostly in males (male 15 cases and female 4 cases). Most patients are diagnosed with PTC at the initial diagnosis [ 2 – 5 , 8 – 10 ] (tall cell PTC 4 cases [ 7 , 11 ] and follicular variant PTC 2 cases [ 5 ]) and undergo RAI ablation [ 2 , 3 , 5 , 6 , 9 , 10 ]. It has been observed that it takes an average of 7 years for pancreatic metastasis to occur.…”

“…A review of the literature found that surgery was performed in 10 out of 18 cases of pancreatic metastasis from PTC, indicating that the surgical method differed depending on the tumor’s location. For example, pancreaticoduodenectomy (PD) [ 8 , 9 ] or enucleation [ 5 , 11 ] was performed when the tumor was located in the pancreatic head, and distal pancreatectomy (DP) [ 5 , 6 ] or DPS [ 3 , 4 ] was performed when the tumor was located in the body or tail. In our case, DPS was performed because the tumor’s location was in the tail.…”

“…In the cases reported by Stein et al [ 11 ], Rossi et al [ 8 ], and Tramontin et al [ 9 ], metastasis to the pancreatic head was found at an average of 7.3 years after the first diagnosis. PD was performed as a treatment, and no recurrence or metastasis to other organs after surgery was reported in all of them.…”

Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer

“…Most were solitary lesions, with half arising in the pancreatic head. Biliary obstruction due to metastatic papillary thyroid cancer has been reported[ 234 ]. EUS-FNA is commonly used for diagnosis, and solitary metastases are generally resected with good results in selected cases[ 235 ].…”