Abstract
Purpose
Distant metastasis from papillary thyroid cancer is rare, and the more frequent site is neck and bone. During follow-up after surgery new distant lesions could appear, while Tg levels remain normal. When suspicious lesions are superficial, fine needle aspiration is the first choice. In case of deeper localization, the diagnosis could need more invasive procedure, such as in case of lung nodules.
Methods
We report a case of a patient with a lung lesion suspicious for metastasis from papillary thyroid cancer. The patient underwent thyroidectomy and radioiodine 10 years before and after 2 years of follow-up was submitted to right cervical lymphadenectomy for nodal recurrence. During the following 5 years Tg values on TSH suppressive treatment ranged 3.7–5.4, always with negative TgAb and negative neck US. CT scans showed the presence of a single nodule in the left lung with subpleuric localization, progressively increasing in size. A CT-guided fine needle aspiration was performed.
Results
The Tg levels measured in the washout out of the Chiba’s needle (386 ng/ml) provided an unequivocal demonstration of the thyroid origin of the nodule.
Conclusions
Thyroglobulin measurement in the specimen obtained from CT-guided fine needle aspiration is a useful and effective tool to diagnose lung metastasis from thyroid cancer. This procedure could avoid a surgical approach that is more invasive and potentially detrimental for the patient.
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References
R. Sciuto, L. Romano, S. Rea et al. Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution. Ann. Oncol. 20(10), 1728–1735 (2009). https://doi.org/10.1093/annonc/mdp050
National Cancer Institute, SEER Cancer Stat Facts: Thyroid Cancer. National Cancer Institute Bethesda MD. (2020). https://seer.cancer.gov/statfacts/html/thyro.html
M.J. Schlumberger, Papillary and follicular thyroid carcinoma. N. Engl. J. Med. 338(5), 297–306 (1998). https://doi.org/10.1056/NEJM199801293380506
Y.K. So, M.J. Kim, S. Kim et al. Lateral lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location. Int. J. Surg. 50, 94–103 (2018). https://doi.org/10.1016/j.ijsu.2017.12.029
I.D. Hay, Papillary thyroid carcinoma. Endocrinol. Metab. Clin. North. Am. 19(3), 545–576 (1990)
L. Giovanella, M. Bongiovanni, P. Trimboli, Diagnostic value of thyroglobulin assay in cervical lymph node fine-needle aspirations for metastatic differentiated thyroid cancer. Curr. Opin. Oncol. 25(1), 6–13 (2013). https://doi.org/10.1097/CCO.0b013e32835a9ab1
P. Trimboli, F. D’Aurizio, R. Tozzoli et al. Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids. Clin. Chem. Lab. Med. 55(7), 914–925 (2017). https://doi.org/10.1515/cclm-2016-0543
F. Pacini, L. Fugazzola, F. Lippi et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 74(6), 1401–1404 (1992). https://doi.org/10.1210/jcem.74.6.1592886
Author contributions
IR: conceptualization, investigation, data curation, writing—original draft, visualization. LR: data curation, investigation, writing—review and editing, visualization. GG: investigation, data curation, writing—original draft. LF: conceptualization, data curation, supervision, writing—review and editing.
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Righi, I., Rosso, L., Grisorio, G. et al. Fine needle aspiration wash out for thyroglobulin determination in the differential diagnosis of lung lesions. Endocrine 71, 253–255 (2021). https://doi.org/10.1007/s12020-020-02363-9
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DOI: https://doi.org/10.1007/s12020-020-02363-9