0
Lung Cancer |

Unraveling the Mystery of Miliary Pulmonary Pattern in an Asymptomatic Female

Hayas Haseer Koya, MBBS; Dona Varghese, MBBS; Sujith Cherian, MD; Sanjay Mukhopadhyay, MD; Roberto Izquierdo, MD
Author and Funding Information

SUNY Upstate Medical University, Syracuse, NY


Chest. 2013;144(4_MeetingAbstracts):628A. doi:10.1378/chest.1703362
Text Size: A A A
Published online

Abstract

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

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Topics

lung

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543