Endocrine Abstracts

A 66-year-old woman had no history of systemic diseases. She had developed watery diarrhea for 4 months initially, without abdominal pain, fever, any aggravating or relieving factor. She visited gastroenterologist, and colonoscopy showed only mixed hemorrhoid. Irritable bowel syndrome was impressed then. Thus, anti-spasmodics and anti-diarrheals were prescribed. However, diarrhea persisted for 1 year, and body weight loss of 7 kg occurred during this period of time. She later visited a general practitioner, and abdominal ultrasonography revealed a 6.9 cm non-cirrhotic hepatic tumor. Her virological markers of HBsAg and anti-HCV were negative, and the serum alpha-fetoprotein level was within normal limits. She was referred to our hospital for further investigation. Tumor markers revealed high CEA (208.5 ng/ml) and normal CA19-9 (35.6 U/ml) levels. Tri-phase abdominal CT scan displayed three non-cirrhotic hypervascular lesions. After admission, core-needle biopsy for the largest hepatic tumor was arranged. Pathology revealed metastatic carcinoma, and immunohistochemical stains showed positive TTF-1, Calcitonin, and Synaptophysin. Thyroid ultrasonogrphy and fine needle aspiration were carried out, by which medullary thyroid carcinoma was impressed. Her serum calcitonin level was more than 10 000 pg/ml. Radical thyroidectomy and liver bi-segmentectomy were done. Amyloid accumulation was noted in the pathological specimens of thyroid and liver. The post-operative serum calcitonin level decreased to 3736 pg/ml, and diarrhea partially improved. Adjuvant chemotherapy was not suggested owing to futile outcome, and further target therapy is under evaluation.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.