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Hndw Pshn CopotonCs Rpots n Gstontstn MdcnVom 2013, Atc ID 386263, 4 pshttp://dx.do.o/10.1155/2013/386263

Case ReportPancreas as Delayed Site of Metastasis fromPapillary Thyroid Carcinoma

Mutahir A. Tunio,1 Mushabbab AlAsiri,1 Khalid Riaz,1 and Wafa AlShakweer2

1 Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 59046, Saudi Arabia2 Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 59046, Saudi Arabia

Cospondnc shod ddssd to Mth A. no; mkhddn@kmc.md.s

Rcvd 4 Fy 2013; Accptd 4 Mch 2013

Acdmc Edtos: P. Ahm nd S. Nom

Copyht 2013 Mth A. no t . Ts s n opn ccss tc dsttd nd th Ctv Commons AtttonLcns, whch pmts nstctd s, dstton, nd podcton n ny mdm, povdd th on wok s popyctd.

Introduction. Foc vnt (FV) ppy thyod ccnom (PC) hs ssv ooc hvo s compd to csscvnt (CV) o PC nd qnty mtstszs to th ns nd ons. Howv, mtstss to th pncs s xtmy mnstton o FV-PC. o dt,ony 9 css o PChv n potd n th tt. Pnctc mtstss om PCsymn symptomtc o mnst s ptd domn chs. Assoctd ostctv jndc s . Ponoss s v wthpotd mdn svv om 16 to 46 months. Case Presentation. Hn w psnt 67-y-od Sd womn, who dvopdpnctc mtstss svn ys f tot thyodctomy nd nck dsscton oowd y doctv odn ton (RAI) o

FV-PC. Mtstsctomy ws pomd y pnctcododnctomy oowd y son s ntc tstn vd BRAFV600E mtton. Sh svvd 32 months f th pnctc mtstss dnoss. Conclusion. Pnctc mtstss mnstton o FV-PC nd sy sn o xtnsv dss nd convnton dnostc toos my mn to ch thdnoss.

1. Introduction

Tyod cnc s th commonst ndocn mnncy,psntn wth 23 500 nw css p y n th UntdStts nd Eopn Unon, spctvy [1, 2]. Dnttdthyod ccnom (DC) s th most qnty dnosd

cnc mon womn n th Mdd Est, hnd ony stcnc, nd ccontn o mo thn 10% o cncsmon womn n Sd A [3].

Ppy thyod ccnom (PC) s th most qntom o DC nd th oc vnt o PC (FV-PC)s mo ssv thn th cssc vnt o PC. It dsom cssc PC n n oc owth pttn, hhpvnc o tmo ncpston, novsc nvson,ndpooy dnttd snd ow t o ymph nodmtstss [4].

Pncs s n xtmy st o mtstss o PC. odt, ony 9 css o pnctc mtstss scondy to PChv n potd n th tt.

Hn w psnt 67-y-od Sd womn, whodvopd pnctc mtstss svn ys f tot thy-odctomy ndnck dsscton oowd y son oFV-PC.

2. Case PresentationIn Novm 2009, 67-y-od Sd womn psntd no cnc o h otn vst wth th compnts o dom-n pn nd ndston. Sh hd notcd ths compntso 2 months nd ths hv n occn qnty ov2 wks, o whch sh ws tkn ntspsmodcs nd nons-tod nt-nmmtoy ds (NSAIDs), t wth mn-m mpovmnt. H pvos mdc hstoy vdhyptnson nd dts snc st 20 ys whch wcontod on mdctons. Sh hd no hstoy o smoknnd h wht ws st. H pst sc hstoy showdtht sh ndwnt tot thyodctomy nd ymph noddsscton o oc vnt ppy thyod ccnom

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Figure 1: Comptd tomophy o nck shown ds nmnt o ht o o thyod, cm ot s ppy oc c vntthyod ccnom p2N1.

Figure 2: Mntc Rsonnc Chonopnctophy (MRCP)shown sm hypovsc 1.8 1.5 cm mss n th pnctcnck, nvdn th spo msntc vn.

p2N1cM0 (F 1) n Mch 2002, oowd y doctvodn (RAI) ton 150mC n My 2002, nd RAI ton150 mC n Jy 2003 o sd sm thyoon vs(39.3 n/mL).

On physc xmnton, sh ws n ood n con-dton nd h vts w st. P domn xmntonvd dp tndnss n pstm; howv, th wsno pp mss o vscomy. T ws no oth p-

p cvc ymphdnopthy nd xmnton o chst,ht, nvos systm, nd pvc ws nom. Cnc d-nt dnoss ws chonc pnctts, pmy pnctcdnoccnom, o mtstss. H hmtooc, n,nd v ncton tsts, tcn, sm ctoyts, ndthyod stmtn homon (SH) nd thyoxn (4) wond wthn nom mts. Sm tmo mks, cc-nomyonc ntn (CEA), nd cnc ntn 19-9 wso nom; howv, sm G vs w sd, tht s,672.8 n/mL (nom: 525 n/mL). Comptd tomophy(C) o domn showd dcsd nhncmnt o thnck, ody, nd t o th pncs; wh nhncmnt oth pnctc hd ppd nom nd th w t

mtp pmony mtstss. Who ody odn scnt-phy ws nonodn vd. Mntc Rsonnc Chon-opnctophy (MRCP) vd sm hypovscson n th pnctc nck msn 1.8 1.5 cm. Itshowd ow sn ntnsty n oth 1 nd 2 wth nonhncmnt n th t phs nd nt nhncmnt ndyd sqncs. Mss ws ttn th spo msn-tc vn (SMV) nd csd nown to ts c owth connc wth spnc vn; howv, spo msn-tc ty (SMA) ws ond nom n c wth no sno nvson(F 2). C dd nndspton cyto-oy o th mss ws pomd nd t showd ppy nstso osnophc tmo cs wth ntnc ncsons. Tptnt ndwnt pnctcododnctomy. Hstoptho-oy showd 1.6 1.4 cm mtsttc dpost n th nck o thpncs nd mmnohstochmsty xmnton showdth postvty o G nd thyod tnscpton cto-1 (F-1) nd md conmd dnoss o pnctc mtstssconsstnt wth FV-PC (F 3). Gntc tstn vd BRAF V600E mtton. Af sc scton, sh wssttd on son 400 m twc dy, whch sh totdw. At tm o smsson o cs pot th ptnt ws vt 36 months postoptvy nd ws don n wth ptspons n ns, wthot cnc n nck nd sm Gvs 39.8 n/mL.

3. Discussion

Pncs s stmtstss. Commonmnncs whchmtstsz to pncs n c ccnom, n,mdy ccnom o th thyod, ymphoms, vohdomyoscom, nd sophs [11]. Mtstss to thpncs om ppy thyod ccnom xtmy. o dt, ony 9 css hv n potd n th ttwth nt dnoss o PC [510, 12] n 1. Exctpthonss s not w known; howv, hmtonosot s w sppotd.

Pnctc mtstss mn symptomtc o onpod o dnoss o mnst s symptoms k choncpnctts s sn n o ptnt. At tm o psntton,

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Cs Rpots n Gstontstn Mdcn 3

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Figure 3: () Inttn csts o ppy tmo csn pnctc tss pnchym (H&E 100) nd () ocpttnwth ndntcytopsm (H&E 200).

able 1: Css o pnctc mtstss scondy to ppy thyod ccnom potd om 1991 to 2012.

Atho A Fom tm o nt ttmnt Vnt tmntSvv f dnosso pnctc mtstss

Zh t . [4] NA NA c Sc scton NA

Sm t . [5] 53 ys 7 ys f + RAI Cssc Sc scton NA

Jon t . [6] 53 ys m NA c Sc scton NA

Ans-Ans t . [7] 72 ys m NA Cssc Sc scton NA

Boschtz t . [8]34 ys m 9 ys f + RAI Cssc

Sc scton 42 months46 ys m 2 ys f + RAI Foc

Chn nd Bnd [9] 82 ys m 5 ys f + RAI Cssc Sc scton NA

Azhn t . [10] 56 ys m 6 ys f + RAI Cssc Son 20 months

Psnt cs 67 ys 7 ys f + RAI c Sc scton nd RAI Av t 32 months

: tot thyodctomy, RAI: doctv odn thpy, NA: not mntond.

pnctc mtstss sy sn o xtnsv dsssn n o ptnt. Convnton dnostc toos (C, WBS)my mn to ch th dnoss. Howv, postonmsson tomophy-comptd tomophy (PE-C) ndndoscopc tsond (EUS) hv shown th snstvtyo dtctn pnctc sons p to 94100%, thoh notpomd n o cs d to nvty n nsttt [13].

Sc ttmnt n th om o pyos spn pnc-tcododnctomy vs th symptoms nd my ncsth dss svv (DFS) o sotd pnctc mts-tss. Howv, djnct nd mtkns nhtos (sono sntn) my sow th dss posson spcy n

ptnts wth BRAF V600E mtton n tmo c ns [14].In concson, pnctc mtstss n FV-PC

nd thy mn symptomtc o ssoctd wth non-spcc compnts. Impovd dnostc toos (MRCP, PE-C, nd EUS) nd mmnohstochmsty cn hp opompt dnoss nd ttmnt y mns o pnctco-dodnctomy oowd y son whch s ssoctdwthncsd DFS.

Consent

Wttn nomd consnt ws tkn om th ptnt o thpcton o ths pp.

Conflict of Interests

T thos dc tht thy hv no potnt conct ontsts.

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