SESSION TITLE: Cancer Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Miliary pulmonary opacities can occur due to a multitude of causes including infections,inflammatory conditions and rarely even malignancies.Distant metastases presenting as miliary lung nodules from occult papillary carcinoma of thyroid is an extremely rare presentation of the tumor.
CASE PRESENTATION: A 19-year-old-female with no significant past medical history was referred to our institution for further evaluation of miliary nodules found incidentally on chest radiograph which were later confirmed by CT chest.The patient denied any particular respiratory complaints and review of systems was otherwise negative. Physical examination was within normal limits. A tuberculin test and sputum for acid-fast bacilli were negative. Bronchoscopy with transbronchial biopsy revealed metastatic papillary thyroid carcinoma. Serum thyroglobulin was also found to be elevated at 2593 ng/ml. A subsequent I-123 scan showed extensive uptake in the neck and lungs.Thyroidectomy with central neck dissection was done which revealed a 3-cm papillary thyroid carcinoma metastatic to 11 of 15 nodes. She then underwent radiation treatment with radioactive iodine over the next year, after which a repeat I 123 scan showed no further uptake in the lungs or neck.Currently forty one months after her initial presentation,she remains asymptomatic.
DISCUSSION: Papillary carcinoma of thyroid usually has an indolent course and has been well documented to be remaining dormant years before diagnosis.It is not uncommon for the condition to present as a metastasis to cervical lymph nodes,irrespective of the size of the cancer. But occult papillary thyroid cancer presenting as distant blood borne metastasis without any obvious cervical lymph node involvement has been reported very rarely.Radiographically, the patterns of presentation of metastatic thyroid cancer may be as solitary or multiple pulmonary nodules,diffuse micronodular,reticular or reticulonodular opacities, which may be confused with conditions like tuberculosis, sarcoidosis or pulmonary eosinophilic granuloma. Bronchoscopy with transbronchial biopsy and bronchoalveolar lavage is key in the diagnostic evaluation of diffuse interstitial disease of the lung.Treatment is by surgical resection-conservative or radical depending on the extent of the tumor.The prognosis of patients after total thyroidectomy depends on the response to I 131 therapy.
CONCLUSIONS: Miliary pattern is a common radiographic pattern involving a heterogeneous group of conditions including infections and inflammatory diseases like sarcoidosis.It may very rarely be the presentation of an occult malignancy, including thyroid cancer.We reiterate the importance of consideration of albeit rare, thyroid malignancies,when faced with a similar diagnostic dilemma, especially in young females.
Reference #1: Chariot P, Feliz A, Monnet I. Miliary opacities diagnosed as lung metastases of a thyroid carcinoma after 13 years of stability. Chest. 1993 Sep;104(3):981-2.
DISCLOSURE: The following authors have nothing to disclose: Hayas Haseer Koya, Dona Varghese, Sujith Cherian, Sanjay Mukhopadhyay, Roberto Izquierdo
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