Anaplastic Thyroid Carcinoma with Prominent Cardiac Metastasis, Accompanied by a Marked Leukocytosis with a Neutrophilia and High GM-CSF Level in Serum.

Abstract

Cardiac metastasis of thyroid carcinoma is extremely rare. We treated a case of anaplastic thyroid carcinoma with prominent cardiac metastasis. The 61-year-old male was admitted because of high fever. Investigations revealed a cardiac mass and anaplastic thyroid carcinoma. Resection of the cardiac mass revealed that it was metastasis from the thyroid carcinoma. After 4 months, he died in spite of intensive therapy. Marked leukocytosis was observed during the clinical course, and a concomitant increase of granulocyte macrophage-colony stimulating factor (GM-CSF) level was demonstrated in the sera. It was suggested that the high GM-CSF level in serum contributed to leukocytosis. (Internal Medicine 31: 1107-1111, 1992 Key words: high fever, cytokine Case Report A 61-year-old male with high fever was admitted to our hospital. From 2 months prior to admission, he had had a fever of above 38.0°C. He first consulted another doctor and received antibiotic therapy because of an elevated peripheral white blood cell (WBC) count. However, there was no response, and he was referred to our hospital for investigation of fever of unknown origin. At the age of about 30 years, he was noted to have a nodular goiter, but since he was asymptomatic, no treat ment was sought. He had no noteworthy family history. On admission, his temperature was 36.0°C, which later increased. His pulse was 90/min, and blood pressure was 104/58mmHg. In the left lobe of the thyroid gland, there was an elastic hard tumor of about 50mm in diam eter, which was mobile and non-tender. No superficial lymph nodes were palpable. On examination, there were no specific findings in the heart, lungs, and abdomen. Laboratory investigations revealed the following values: hemoglobin, ll.0g/dl; red blood cell count, 3,970,000/mm3; platelet count, 153,000/mm3; WBC count, 35,300/mm3 (segmented neutrophil, 65% ; band neutrophil, 23%; lymphocyte, 8%; monocyte, 3%; metamyelocyte, 1%); total protein, 5.0g/dl; albumin, 2.5 g/dl; glutamate oxaloacetate transaminase, 12IU/1 (normal, 7-27); glutamate pyruvate transaminase, 59 IU/1 (normal, 0-24); lactate dehydrogenase, 526 IU/1 (normal, 213-397); alkaline phosphatase (ALP), 331 IU/1 (normal, 39-118); leucine aminopeptidase, 113 IU/1 (normal, 31-54); gamma-glutamyl transpeptidase (y-GTP), 190IU/1 (normal, 5-42); serum calcium, 4.0 milliequivalent/1. Serum creatinine, blood urea nitrogen, and other electrolytes were within the normal range. The prothrombin time and activated partial thromboplastin time were also within the normal range. The erythrocyte sedimentation rate was 74mm/h and C-reactive protein was 13.6mg/dl (normal, less than 0.3). Serum thyroid stimulating hormone, free thy roxine, and free triiodothyronine level were respectively 0.67^IU/1 (normal, 0.35-3.78), 0.90pg/ml (normal, 0.93-1.73), and 0.61ng/ml (normal, 2.7-5.0). Serum carcinoembryonic antigen, calcitonin, and thyroglobulin were respectively 0.6ng/ml (normal, 0-4.0), HOpg/ml (normal, less than 100), and 3,000ng/ml (normal, less than 30). Urinary examination ...

Papillary thyroid carcinoma producing granulocyte-macrophage colony-stimulating factor is associated with neutrophilia and eosinophilia

“…Most of the reported patients with thyroid tumors and paraneoplastic leukocytosis had neutrophilia, [11][12][13][14]17 few had eosinophilia, [19][20][21][22] and only one had both neutrophilia and eosinophilia, 15 as the patient we describe. Production of colony-stimulating factors, such as G-CSF, [13][14][15] GM-CSF 15,16 and M-CSF 17 by the tumor, has been related to paraneoplastic leukocytosis, although the mechanism of induction of this haematologic abnormality remains unknown.…”

“…12,15,16 In the case described by Murabe et al, 12 high circulating levels of GM-CSF were detected, although the authors do not comment on whether other colony-stimulating factors were evaluated. It has to be noted that these three patients had anaplastic thyroid cancer.…”

“…[11][12][13][14][15][16][17] Only two patients with differentiated thyroid cancer have thus far been reported, one with papillary type associated with neutrophilia 18 and one with medullary type associated with eosinophilia. 19 We report a patient with metastatic thyroid papillary carcinoma, in whom marked neutrophilia and eosinophilia and high circulating levels of GM-CSF were detected.…”

Cardiac metastasis from primary anaplastic thyroid carcinoma: report of three cases and a review of the literature.

“…Myocardial metastases, which are rarely diagnosed ante mortem, often represent the terminal stage of a malignant disease and are associated with generally widespread metastasis. Over the last 20 years, only 10 cases of cardiac metastasis from thyroid tumors have been described in the total literature (Kurasawa et al 1981, Inoue et al 1984, Carcangiu et al 1985, Hara et al 1986, Yamamori et al 1986, Murata et al 1991, Murabe et al 1992, Larsimont et al 1998.…”

“…However, in contrast to differentiated thyroid cancer (papillary and follicular), anaplastic thyroid cancer (ATC) is considered one of the most aggressive neoplasms encountered in humans (Giuffrida & Gharib 2000). To our knowledge, over the last 20 years, only four cases of cardiac metastasis from thyroid cancer have been reported in the English (Carcangiu et al 1985, Murabe et al 1992, Kim et al 2000, five in the Japanese (Kurasawa et al 1981, Inoue et al 1984 Murata et al 1991), and two in the French (Larsimont et al 1998) literature. Here, we present three cases of ATC with metastatic involvement of the heart.…”