Endocrine Abstracts

JOINT2304

Introduction: Papillary thyroid carcinoma is the most common histological type of thyroid cancer. Its spread is essentially lymphatic. Its prognosis is generally very good, and metastases are rare. We will illustrate a case of a patient with papillary carcinoma revealed by metastatic localization.

Observation: This 86-year-old patient presented with an altered general condition and persistent cough. A cervico-thoracic CT scan was performed, revealing multiple secondary pulmonary balloon lesions and a suspicious hepatic nodule. Clinical examination revealed a fixed, hard 2 cm cervical swelling. Cervical ultrasound revealed several eutirad nodules 3 and 5 associated with a highly suspicious laterocervical adenopathy. A total thyroidectomy with lymph node dissection was performed, and pathological examination revealed an infiltrating papillary carcinoma with vascular emboli.

Discussion: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for around 70-80% of cases. This cancer is generally well-differentiated and has a good prognosis, with high long-term survival. However, in some cases, it may be discovered atypically. Differentiated thyroid carcinomas rarely metastasize. Papillary thyroid carcinoma has a well-known tendency to spread to cervical lymph nodes, particularly in the jugular and supraclavicular areas. However, distant dissemination to other organs is less frequent. Distant localization is mainly to the lungs and bones. The standard treatment for distant metastases remains surgery, particularly if the metastases are limited and accessible. However, chemotherapy or radiotherapy may be necessary for more advanced cases or those where surgery is not possible. Treatment consists of total thyroidectomy with lymph node dissection. Adjuvant treatments, such as radioactive iodine (I-131), are also used in cases where the cancer remains differentiated and can accumulate iodine. The prognosis of patients with metastatic disease from papillary thyroid carcinoma is generally favourable, especially if the metastases are limited and accessible. However, in the most aggressive forms with diffuse metastases, the prognosis is less favourable.

Conclusions: Papillary thyroid carcinomas revealed by metastases are rare but present a major diagnostic and therapeutic challenge.