A distinctive colour associated with high iodine content in malignant pleural effusion from metastatic papillary thyroid cancer: a case report

Journal of Medical Case Reports

YC Gary Lee¹  Michael Millward⁴  Ee Mun Lim²  Andrew Rosenstengel³ 

[1] Centre for Asthma, Allergy & Respiratory Research, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia;Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, QEII Medical Centre, Hospital Avenue, Nedlands, Perth, WA, 6009, Australia;Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA, 6009, Australia;School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia

关键词: Colour;    Carcinoma;    Thyroid;    Diagnosis;    Thyroglobulin;    Iodine;    Pleural effusion;   

Others  :  1181172
DOI  :  10.1186/1752-1947-7-147

 received in 2013-01-21, accepted in 2013-04-15,  发布年份 2013

【 摘 要 】

Introduction

Pleural effusions are a common clinical problem and affect about one million people in the United States and United Kingdom each year. Over 60 causes of pleural effusion have been identified; establishing the definitive aetiology can be difficult, and often requires invasive procedures. Guidelines state that macroscopic examination of the fluid should be the first step in determining the aetiology of a pleural effusion. Papillary thyroid carcinoma is an uncommon cause of malignant pleural effusion, with only 10 cases reported in the literature, their physical characteristics and composition having been rarely described. We describe for the first time a distinctive brown colour of the malignant effusion (despite centrifugation) from a rare case of metastatic papillary thyroid cancer to the pleura, associated with a high pleural fluid iodine content. Such a characteristic may be useful in expediting diagnosis of a malignant pleural effusion in the appropriate clinical context.

Case presentation

We present the case of a 71-year-old Caucasian man with metastatic papillary thyroid cancer; a large, long-standing, right-sided pleural effusion and a 83-fold higher pleural thyroglobulin level compared to corresponding serum, supporting this malignancy as the cause of the patient’s effusion. The pleural fluid had a distinctive pigmentation similar to iodine-containing antiseptic preparations. Biopsy during medical thoracoscopy confirmed metastatic papillary thyroid carcinoma. Analysis of pleural fluid showed a pleural thyroglobulin level over 80 times that of serum levels (29,000μg/L versus 350ug/L). Pleural fluid iodine content was 23,000ug/L and may account for the fluid’s distinctive pigment, as iodine is an essential component in thyroglobulin and thyroid hormone synthesis.

Conclusions

Pleural fluid pigmentation may aid diagnosis in the appropriate clinical setting. A distinctive iodine-like brown colour of pleural fluid may represent elevated iodine content and should raise consideration of metastatic thyroid cancer as a cause for a pleural effusion.

【 授权许可】

   
2013 Rosenstengel et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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