Pancreatic metastasis of papillary thyroid carcinoma preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report with review of literatures

Abstract

Pancreatic metastatic tumors from thyroid carcinoma are extremely rare. We report a case of an 80-year-old female with a pancreatic metastatic tumor derived from papillary thyroid carcinoma which was initially resected 158 months prior to detection of the metastatic pancreatic tumor. The patient has encountered cervical lymph-node metastasis on three occasions following the initial operation. Metastatic pancreatic lesions and cervical lymph nodes were first detected using 18-fluorodeoxyglucose positron-emission tomography/computed tomography, and she was preoperatively diagnosed using endoscopic ultrasound-guided fine-needle aspiration biopsy. A coin lesion, 10 mm in size, was detected in the left lung by chest computed tomography with no abnormal uptake in 18-fluorodeoxyglucose positron-emission tomography/computed tomography. Distal pancreatectomy and cervical lymph-node dissection were performed. Adjuvant chemotherapy with weekly paclitaxel was administered because anaplastic transformation had been detected in one of the cervical lymph nodes. The patient eventually died from multiple lung metastases 11 months after removing the metastatic pancreatic lesion. We reported a rare case of a pancreatic metastatic tumor from thyroid carcinoma, and found that 18-fluorodeoxyglucose positron-emission tomography/computed tomography and endoscopic ultrasound-guided fine-needle aspiration biopsy are useful for preoperatively diagnosing tumors.

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

“…Occurrence is rare, moreover is the first time that altered liver biochemistry and typical symptoms of cholestatic syndrome are the initial presentation. Of the reported cases, 35% describe isolated abdominal pain as initial symptom and 28% asymptomatic elevated Tg (6,14). Even thought the clinicopathologic features of unusual metastasis in PTC are not well established (12), previous known characteristics of poor prognosis and high risk of general distant metastasis in our case included older age and male gender additionally to high risk of recurrence, TNM classification (7th TNM: IVc, 8th TNM: IVb) and the development of radioactive iodine refractoriness.…”

“…Most previously reported patients have known advanced cancer with other organs metastases at the time pancreatic lesion is discovered (10,14,(16)(17)(18)(19)21,22). Even though time for diagnosis was variable from one month to fifteen years after TT, and as an exception, in one case PTC diagnosis was done after pancreatectomy (10).…”

“…Fourteen cases have been described so far, occurring up to 15 years after initial therapy. The treatments modalities described varied from surgery, chemotherapy, tyrosine kinase inhibitors (TKI), and active surveillance (6,10,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Regarding survival, the benefit of metastasectomy has been observed for renal cell carcinoma metastases (25).…”

Metástasis pancreática como debut de carcinoma papilar de tiroides. Caso clínico y revisión del perfil clínico patológico y molecular

“…La metástasis de CPT en páncreas es extremadamente rara, con 24 casos publicados hasta la fecha, de edad promedio 59 años (rango 39-82). El tiempo transcurrido entre el diagnóstico inicial de CPT y la aparición de la metástasis pancreática fue 83 meses (rango 0-192), con aparición hasta 10 años luego de la presentación inicial 5 . Respecto al pronóstico, la sobrevida promedio reportada es de 8,7 meses, con 5 pacientes que han sobrevivido más de 4 años 5,6 .…”

“…Si bien el CPT está generalmente asociado a un excelente pronóstico, cuando presenta metástasis a distancia la sobrevida a 5 años disminuye hasta 15-70%, dependiendo del tamaño de las metástasis y su avidez por radioyodo 1,4 . La metástasis pancreática de CPT es extremadamente rara, reportándose solo 24 casos en la literatura 5 . A continuación, presentamos un paciente que debutó con ictericia obstructiva secundaria a metástasis de CPT en cabeza de páncreas.…”