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Journal of Cancer Research and Therapeutics, Vol. 4, No. 1, January-March, 2008, pp. 44-45 Brief Communication Endobronchial metastasis of follicular thyroid carcinoma presenting as hemoptysis: A case report RAS Kushwaha, Sanjay Kumar Verma, Sanjay Vineet Mahajan Department of Pulmonary Medicine, King George's Medical University, Lucknow - 226 003 Code Number: cr08011 Abstract Endobronchial metastasis secondary to follicular thyroid carcinoma is extremely rare. Here, we report a case of follicular thyroid cancer in 58-year-old male who presented with hemoptysis. Computed tomography of the chest revealed multiple lung metastases. Flexible fiberoptic bronchoscopy revealed a fragile polypoid mass 5 cm distal to the vocal cords; biopsy taken from this mass revealed follicular thyroid carcinoma.Keywords: Follicular thyroid carcinoma, hemoptysis Endobronchial metastasis due to follicular thyroid carcinoma are very rare and may be life threatening due to their ability to cause massive hemoptysis. There are only a few cases reported in the literature of endobronchial metastasis secondary to follicular carcinoma of the thyroid. [1],[2],[3] Here, in view of its clinical rarity, we present a case of follicular thyroid carcinoma with endobronchial metastasis, presenting as hemoptysis. Case History A 58-year-old male, nonsmoker was admitted to our department with the complaints of recurrent hemoptysis and stridor for the last 1 month. The resting pulse rate was 102/min and his respiratory rate was 26/min. His blood examination revealed hemoglobin: 12.2 gm%; total leukocyte count: 10,100 cells/mm 3 ; differential leukocyte count: neutrophils 76%, lymphocytes 21%, monocytes 1%, and eosinophils 2%. The platelet count was 2,54,000/mm 3 . His bleeding profile and thyroid profile were normal. He had a mass on the left side of his neck that had been growing in size. The rest of his general examination and chest examination revealed no abnormality. His chest x-ray was not very informative [Figure - 1]. CT thorax revealed multiple nodular opacities suggestive of metastasis in both lungs [Figure - 2]. Flexible fiberoptic bronchoscopy revealed a fragile polypoid mass on the lateral wall of the trachea, almost occluding the whole of the lumen; it was 5 cm distal to the vocal cords [Figure - 3]. Biopsy, taken from this mass, revealed follicular thyroid carcinoma. Ultrasonographic-guided biopsy from the left lobe of the thyroid space-occupying lesion was taken and it also revealed follicular thyroid carcinoma. Thus, a diagnosis of stage IV follicular thyroid carcinoma presenting as hemoptysis was established. A subtotal thyroidectomy under general anesthesia was done and was followed by external beam radiotherapy, with a total dose of 54 Gy. A total of 27 cycles with a dose of 2 Gy/cycle were given and 5 cycles were given per week. After this treatment, the hemoptysis did not recur and the patient was discharged.Discussion Clinically, follicular thyroid carcinoma presents as a palpable, firm, and nontender thyroid lump. Symptoms like pain, stridor, vocal cord paralysis and, rarely, hemoptysis can be the presenting feature in advanced thyroid cancers involving the trachea [4] (as in present case). The most common sites of metastasis of follicular carcinoma of the thyroid are bone, lung, and the central nervous system; endobronchial metastases are very rare. To the best of our knowledge, only three cases of Hurthle cell carcinoma have been reported previously. [1],[2],[3] Although endobronchial metastasis of follicular carcinoma of the thyroid is very rare, it is important to keep the possibility in mind because the presence of such metastasis may be life threatening due to the risk of massive hemoptysis. [5] Endobronchial metastasis can be associated with partial or complete obstruction of the bronchial lumen. In the presence of airway obstruction, a differential diagnosis of tracheal invasion by thyroid carcinoma should be considered. [6] The simplest way to establish the diagnosis is by fine needle aspiration biopsy (FNAB) (as was done in the present case). [7] Thyroid biopsy can also be performed using the Tru-Cut or Vim-Silverman needles, but FNAB is preferable. MRI and CT scan are not usually done to diagnose thyroid cancer, but can be used to assess the spread of the disease. After detection of endobronchial metastasis, the median survival is about nine months [2] and some therapeutic procedures such as brachytherapy, laser therapy, electrocoagulation, cryotherapy, forceps removal, stent placement, and external radiation may provide symptomatic improvement. Treatment of the primary malignancy along with these therapeutic procedures may prolong the median survival. [2],[8] Thus, when a patient with a thyroid mass and multiple nodular shadows in the lungs presents with hemoptysis, the possibility of thyroid cancer should be kept in mind. References
Copyright 2008 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr08011f3.jpg] [cr08011f1.jpg] [cr08011f2.jpg] |
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