Unusual metastases from differentiated thyroid carcinoma: analysis of 36 cases
- 73 Downloads
Metastases of differentiated thyroid cancer (DTC) in sites different from lungs and bone are unusual (UM); their impact in management and prognosis remains unknown. Our aim was to evaluate the prevalence of UM, to describe their characteristics and to analyze their impact in disease outcome and mortality.
We retrospectively reviewed the file records from 8 different centers. Those patients with DTC and UM were included. UM were diagnosed by: (i) biopsy/cytology and/or (ii) radioiodine (RAI) uptake associated to elevated thyroglobulin (Tg) levels and/or c) presence of one or more structural lesion/s with 18-FDG uptake in the PET/CT scan and elevated Tg levels.
Thirty-six (0.9%) out of a total of 3982 DTC patients were diagnosed with UM; 75% had papillary histology. The most frequent localization was central nervous system (CNS, 31%). UM were metachronous in 75%, symptomatic in 55.6% and fulfilled RAI-refractoriness criteria in 77.8% of cases. Metastatic lesions in lung/bone and/or locoregional disease were present in 34 cases (94.4%). Diagnosis of UM changed the therapeutic approach in 72.2% of patients. After a median follow up of 13 months, 21 (58.3%) patients died from DTC related causes. In 8 of them CNS progression was the immediate cause of death.
Prevalence of UM was low; they were frequently metachronic and RAI-refractory. Although UM were found in patients with widespread disease, their diagnosis usually led to changes in therapy. UM were associated with poor prognosis and high frequency of disease-specific mortality.
KeywordsThyroid carcinoma Distant metastases Unusual metastases Advanced thyroid cancer Radioiodine refractory
We thank the members of the Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo: Abalovich Marcos, Abelleira Erika, Alcaraz Graciela, Bielski Laila, Brenta Gabriela, Cabezón Carmen, Calabrese María, Castro Jozami Lorena, Cavallo Andrea, Corino Mirta, Deutsch Susana, Frascaroli Genoveva, Gauna Alicia, Guerra Jorgelina, Gutierrez Silvia, Iorcansky Sonia, Löwenstein Alicia, Martínez Maria, Moldes Sofia, Negueruela Maria, Oneto Adriana, Orlandi Ana, Parisi Carina, Rosemblit Cinthia, Russo Picasso Maria, Saban Melina, Sartorio Gerardo, Schnitman Marta, Silva Croome Maria, Storani Maria, Vazquez Adriana, Zund Santiago.
Compliance with ethical standards
Conflict of interest
F.P. is medical advisor, speaker, and Steering Committee Bayer and Consultancy/Speaker bureau for Sanofi and Raffo Laboratories. E.F. is medical advisor and speaker for Sanofi and Speaker for Bayer and Raffo Laboratories. I.C. is medical advisor and speaker for Sanofi and Speaker for Bayer and Raffo Laboratories. The remaining authors declare that they have no conflict of interest.
This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. As this was a retrospective non interventional study, written consent was deemed unnecessary.
- 2.B.R. Haugen, 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2016)CrossRefGoogle Scholar
- 10.M.B. Amin, S. Edge, F. Greene, D.R. Byrd, R.K. Brookland, M.K. Washington, J.E. Gershenwald, C.C. Compton, K.R. Hess, D.C. Sullivan, J.M. Jessup, J.D. Brierley, L.E. Gaspar, R.L. Schilsky, C.M. Balch, D.P. Winchester, E.A. Asare, M. Madera, D.M. Gress, L.R. Meyer AJCC Cancer Staging Manual, 8th edn. (Springer, New York, 2017)Google Scholar
- 11.F. Pitoia, Consenso intersocietario sobre tratamiento y seguimiento de pacientes con cáncer diferenciado de tiroides. Inter Society Consensus for the Management of Patients with Differentiated Thyroid Cancer. Rev. Arg. Endocrinol. Metab. 51(2), 85–118 (2014)Google Scholar
- 20.I. Slutzky-Shraga, Clinical characteristics and disease outcome of patients with non-medullary thyroid cancer and brain metastases. Oncol. Lett. 15(1), 672–676 (2018)Google Scholar
- 21.National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines). Thyroid carcinoma (version 3. 18) https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed 8 March 2019.
- 29.M.A. Tunio, Pancreas as delayed site of metastases from papillary thyroid carcinoma. Case Rep. Gastrointest. Med. 2013(386263), 1–4 (2013). https://doi.org/10.1155/2013/386263
- 31.M.A. Tunio, Skeletal-muscle metastasis as an initial presentation of follicular thyroid carcinoma: a case report and a review of the literature. Case Rep. Endocrinol. 2013(192573), 1–4 (2013). https://doi.org/10.1155/2013/192573