PDF(Pubmed)
Abstract：
BACKGROUND: Follicular thyroid carcinoma is the second most common malignancy of the thyroid gland. In 2016, the so-called Hurthle cell thyroid carcinoma, formerly known as the oxyphilic variant of the follicular thyroid carcinoma, was reclassified by the World Health Organization as a separate pathological entity, which accounts for approximately 3% of all thyroid cancers. Although Hurthle cell thyroid carcinomas are known for their more aggressive tumor biology, metastases are observed in a minority of cases, and long-term survival can be expected. However, disseminated disease is often associated with poor outcome.
METHODS: In the presented case, a 63-year-old Caucasian female was incidentally diagnosed with Hurthle cell thyroid carcinoma after undergoing hemithyroidectomy for a nodular goiter. Following completion thyroidectomy, two courses of radioactive iodine therapy were administered. After 4 years of uneventful follow-up, the patient gradually developed metastases in five different organs, with the majority representing unusual sites, such as heart, kidney, and pancreas over a course of 14 years. The lesions were either treated with radioactive iodine therapy or removed surgically, depending on iodine avidity.
CONCLUSIONS: Follicular and Hurthle cell thyroid carcinoma are known to potentially spread hematogenously to typical sites, such as lung or bones, however; unusual metastatic sites as presented in our case can also be observed. A search of the literature revealed only scattered reports on patients with multiple metastases in unusual locations. Furthermore, the observed long-term survival of our patient is contradictory to the existing data. As demonstrated, recurrent disease may appear years after the initial diagnosis, emphasizing the importance of consistent aftercare. Radioactive iodine therapy, extracorporeal radiation therapy, and surgical metastasectomy are central therapeutic components. In summary, our case exemplifies that thorough aftercare and aggressive treatment enables long-term survival even in recurrent Hurthle cell thyroid carcinoma displaying unusual multisite metastases.
METHODS: In the presented case, a 63-year-old Caucasian female was incidentally diagnosed with Hurthle cell thyroid carcinoma after undergoing hemithyroidectomy for a nodular goiter. Following completion thyroidectomy, two courses of radioactive iodine therapy were administered. After 4 years of uneventful follow-up, the patient gradually developed metastases in five different organs, with the majority representing unusual sites, such as heart, kidney, and pancreas over a course of 14 years. The lesions were either treated with radioactive iodine therapy or removed surgically, depending on iodine avidity.
CONCLUSIONS: Follicular and Hurthle cell thyroid carcinoma are known to potentially spread hematogenously to typical sites, such as lung or bones, however; unusual metastatic sites as presented in our case can also be observed. A search of the literature revealed only scattered reports on patients with multiple metastases in unusual locations. Furthermore, the observed long-term survival of our patient is contradictory to the existing data. As demonstrated, recurrent disease may appear years after the initial diagnosis, emphasizing the importance of consistent aftercare. Radioactive iodine therapy, extracorporeal radiation therapy, and surgical metastasectomy are central therapeutic components. In summary, our case exemplifies that thorough aftercare and aggressive treatment enables long-term survival even in recurrent Hurthle cell thyroid carcinoma displaying unusual multisite metastases.
摘要：
背景：滤泡性甲状腺癌是甲状腺第二常见的恶性肿瘤。2016年，所谓的Hurthle细胞甲状腺癌，以前被称为滤泡性甲状腺癌的嗜氧变体，被世界卫生组织重新分类为一个独立的病理实体，约占所有甲状腺癌的3%。尽管Hurthle细胞甲状腺癌以其更具侵袭性的肿瘤生物学而闻名，在少数病例中观察到转移，和长期生存是可以预期的。然而,播散性疾病通常与不良预后相关。
方法：在本案例中，一名63岁的白种人女性因结节性甲状腺肿接受半甲状腺切除术后,偶然诊断为甲状腺Hurthle细胞癌.完成甲状腺切除术后，接受了两个疗程的放射性碘治疗。经过4年的平静随访，病人逐渐在五个不同的器官发生转移，大多数代表不寻常的地点，如心，肾,和胰腺在14年的过程中。病灶或接受放射性碘治疗或手术切除,取决于碘的亲和力。
结论：已知甲状腺毛囊和Hurthle细胞癌可能通过血液向典型部位扩散，如肺或骨骼，然而，在我们的病例中也可以观察到不寻常的转移部位。对文献的搜索显示，只有关于在不寻常位置发生多发转移的患者的零散报道。此外，我们观察到的患者长期生存率与现有数据相矛盾.正如所证明的，复发性疾病可能在初次诊断后数年出现，强调一致的善后护理的重要性。放射性碘治疗,体外放射治疗,外科转移瘤切除术是治疗的核心组成部分。总之,我们的案例表明,即使在复发性甲状腺Hurthle细胞癌出现不寻常的多部位转移的情况下,彻底的善后护理和积极治疗也能长期生存.
方法：在本案例中，一名63岁的白种人女性因结节性甲状腺肿接受半甲状腺切除术后,偶然诊断为甲状腺Hurthle细胞癌.完成甲状腺切除术后，接受了两个疗程的放射性碘治疗。经过4年的平静随访，病人逐渐在五个不同的器官发生转移，大多数代表不寻常的地点，如心，肾,和胰腺在14年的过程中。病灶或接受放射性碘治疗或手术切除,取决于碘的亲和力。
结论：已知甲状腺毛囊和Hurthle细胞癌可能通过血液向典型部位扩散，如肺或骨骼，然而，在我们的病例中也可以观察到不寻常的转移部位。对文献的搜索显示，只有关于在不寻常位置发生多发转移的患者的零散报道。此外，我们观察到的患者长期生存率与现有数据相矛盾.正如所证明的，复发性疾病可能在初次诊断后数年出现，强调一致的善后护理的重要性。放射性碘治疗,体外放射治疗,外科转移瘤切除术是治疗的核心组成部分。总之,我们的案例表明,即使在复发性甲状腺Hurthle细胞癌出现不寻常的多部位转移的情况下,彻底的善后护理和积极治疗也能长期生存.
