Occult Papillary Thyroid Carcinoma in Hashimoto's Thyroiditis Presenting as a Metastatic Bone Tumor

Endocrine Journal

MITSUSHIGE NISHIKAWA²  NORIKO SAKAIDA⁴  NORIKO SAKAGUCHI²  TOSHIO YAMASHITA³  TOSHIKO TOKORO²  MITSUO INADA²  AKIHARU OKAMURA⁴  SAKUYOSHI TABATA²  TOSHINAGA YONEMOTO²  ATSUKO FUJIYAMA²  NAGAOKI TOYODA²  NORIKO YOSHIKAWA²  KANJI KASAGI¹  MASAYOSHI YOSHIMURA²  YOSHIFUMI OGAWA²  HIROFUMI KUMAZAWA³ 

[1] Department of Nuclear Medicine, Graduate School of Medicine, Kyoto University;Second Department of Internal Medicine, Graduate School of Medicine, Kyoto University;Departments of Otorhinolaryngology, Graduate School of Medicine, Kyoto University;Surgical Pathology, Kansai Medical University

关键词: Thyroid cancer;    Hashimoto's disease;    Metastasis;    Scintigraphy;    Regression;   

DOI  :  10.1507/endocrj.45.111

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(20)Cited-By(4)Some occult thyroid carcinomas are hypothesized to regress and be eventually obliterated. We report here a patient whose condition supports this hypothesis. A 51-year-old male with primary hypothyroidism due to Hashimoto's thyroiditis suffered from a rib bone tumor. He had a diffuse goiter with no nodular lesion. Serum FT4 and TSH concentrations were 0.8ng/dl and 36.4μU/ml on taking 100μg/day of T4. Anti-Tg- and -TPO-Ab were strongly positive (99 and 1380U/ml). The iodine 123 scintigraphy demonstrated clear accumulation in the rib tumor, whereas the thyroid was scarcely visible. Biopsy of the rib tumor showed papillary proliferation of large atypical cells, which were immunohistochemically positive for thyroglobulin. Metastatic bone tumor of papillary thyroid carcinoma was therefore strongly suspected. He underwent a total thyroidectomy and the thyroid was stepwise sectioned completely at 3mm intervals. The thyroid condition was diagnosed as Hashimoto's thyroiditis demonstrating diffuse and dense fibrosis, lymphocyte infiltration with lymphoid follicles and flattened atrophied follicles, but no carcinomatous foci were found. He was treated with I-131 and scintigraphy after the ingestion showed distinct accumulation in the rib tumors similar to that before thyroidectomy. No other abnormal uptake was observed. It is suggested that the primary occult thyroid papillary carcinoma regressed and was obliterated possibly by some immunologic or other hostresistance factors after it metastasized to the distant bone.

【 授权许可】

Unknown