Endocrine Abstracts

A 49 year-old Filipino male presented at the emergency room because of progressive dyspnea. He was diagnosed with papillary thyroid carcinoma by fine needle aspiration biopsy of his 7×5 cm thyroid mass 3 months prior to his current consultation. He was scheduled to undergo total thyroidectomy but he opted to postpone his surgery due to intermittent cough. On admission, a pulmonary mass with pleural effusion on the right was noted on chest radiograph. He was considered to have papillary thyroid carcinoma with pulmonary metastases and malignant effusion. Ultrasound guided biopsy of the 3×5.8×5.3 cm pulmonary mass and cytologic studies of pleural fluid, however, revealed adenocarcinoma compatible with primary lung malignancy. Chest tube thoracostomy with JP drainage was done which resulted to improvement of the dyspnea. Plan was to do pleurodesis and chemotherapy of the more aggressive malignancy, the pulmonary adenocarcinoma, then total thyroidectomy, radioactive iodine ablation and thyroxine suppression therapy of the papillary thyroid carcinoma. However, patient developed sudden dyspnea and expired from pulmonary embolism.

The coexistence of two primary carcinoma – pulmonary adenocarcinoma and papillary thyroid carcinoma is a rare event. The relationship between these two cancers is still unclear. Management should focus on the more aggressive carcinoma first. In this case, it is the pulmonary adenocarcinoma since the latter carcinoma is known for its indolent course and better prognosis than the former.