Thyroid cancer: with an unexpected location in the pancreas and in an unexpected combination with Boecks sarcoidosis
Zsuzsanna Valkusz1, Éva Csajbók1, János Gardi1, Lilla Kardos2, László Tiszlavicz3 & László Pávics4
The incidence of differentiated thyroid cancer gradually increased in the last few decades. Primery thyroid cancer is usually located in the thyroid gland and can be classified into well differentiated and poorly differentiated forms. Sooner or later, these cancers metastatize into local lymphnodes or distant organs.
We present the histories of two patients with anusual forms of thyroid cancer.
A woman of 64 was admitted in our department in 2004, due to an inoperable tumor in the pancreas. Histological sampling revealed a well differentiated ectopic follicular thyroid cancer. After total thyroidectomy (no malignancy in the thyroid), 131-I scintigraphy showed isotope accumulation int he pancreas.
Repeated high-dose 131-I therapy shrank the size of the pancreatic tumor and markedly decreased the thyroglobulin level in the serum. One year after these interventions, the patient feels well, has no further distant metastases and is treated for insulin-dependent diabetes mellitus; TSH is sctrictly suppressed by thyroxine medication.
A man 28 was admitted in our department for severe dyspnea in 2004. The computed tomography of the chest detected disseminated patches in the lung with enlarged lymphnodes both int he mediastinum and ont he neck. Total thyroid surgery plus modified cervical and mediastinal lymphnode dissection showed a papillary type thyroid cancer metastatizing into the lung and combined with Boecks sarcoidosis. Postoperative thyroglobulin level was foud extremely high and 131-I scintigraphy showed pulmonary accumulation. Repeated radioiodine treatment resulted in decreasing thyreogobulin level and strongly improved picture of the chest by computed tomography. The patient is under TSH suppressing therapy.