PDF(Pubmed)
Abstract：
UNASSIGNED: Follicular thyroid cancer (FTC) typically spreads hematogenously, with bone metastasis being worrisome, often appearing to be resistant to radioactive iodine (RAI) therapy. Metastasis to sternum is exceedingly rare.
METHODS: A 43-year-old Egyptian male presented with chest tightness, cough, and shortness of breath. He was initially treated as bronchial asthma. Later, he was referred to our thyroid surgery clinic as a case of goitre and palpable sternal mass. He looked clinically well, with enlarged anterior neck mass and visible sternal mass, no lymphadenopathy. Laboratory tests showed thyroid-stimulating hormone levels within normal (2.13 mIU/L), and mildly decreased FT4 (10.3 pmol/L). Neck/chest CT demonstrated multinodular goitre with retrosternal extension, expansile lytic lesion in the sternum, and bilateral lung metastases. Thyroid fine needle aspiration and cytology showed FLUS, and true cut biopsy from the sternal lesion showed invasive FTC.
CONCLUSIONS: Rare bilateral FTC presenting as slow-growing sternal metastasis. The patient underwent total thyroidectomy, followed by high dose RAI therapy, and concluded with sternectomy and reconstruction surgery repair using polymethyl methacrylate wrapped in proline mesh. On follow-up, he received further RAI ablation therapy and became RAI refractory. He then received systemic therapy (Lenvatinib). Most recent follow up showed that the disease was controlled (low volume cancer) and he was tolerating treatment well with no reported symptoms.
CONCLUSIONS: Bilateral FTC with sternal metastasis is rare, and can be treated with total thyroidectomy, sternectomy and reconstruction, followed by RAI therapy and systemic therapy where required, hence inferring real survival benefit.
METHODS: A 43-year-old Egyptian male presented with chest tightness, cough, and shortness of breath. He was initially treated as bronchial asthma. Later, he was referred to our thyroid surgery clinic as a case of goitre and palpable sternal mass. He looked clinically well, with enlarged anterior neck mass and visible sternal mass, no lymphadenopathy. Laboratory tests showed thyroid-stimulating hormone levels within normal (2.13 mIU/L), and mildly decreased FT4 (10.3 pmol/L). Neck/chest CT demonstrated multinodular goitre with retrosternal extension, expansile lytic lesion in the sternum, and bilateral lung metastases. Thyroid fine needle aspiration and cytology showed FLUS, and true cut biopsy from the sternal lesion showed invasive FTC.
CONCLUSIONS: Rare bilateral FTC presenting as slow-growing sternal metastasis. The patient underwent total thyroidectomy, followed by high dose RAI therapy, and concluded with sternectomy and reconstruction surgery repair using polymethyl methacrylate wrapped in proline mesh. On follow-up, he received further RAI ablation therapy and became RAI refractory. He then received systemic therapy (Lenvatinib). Most recent follow up showed that the disease was controlled (low volume cancer) and he was tolerating treatment well with no reported symptoms.
CONCLUSIONS: Bilateral FTC with sternal metastasis is rare, and can be treated with total thyroidectomy, sternectomy and reconstruction, followed by RAI therapy and systemic therapy where required, hence inferring real survival benefit.
摘要：
■滤泡性甲状腺癌（FTC）通常通过血液传播，骨转移令人担忧，通常表现为对放射性碘（RAI）治疗有抗性。胸骨转移极为罕见。
方法：一名43岁的埃及男性胸闷，咳嗽,呼吸急促.他最初被治疗为支气管哮喘。稍后，他因甲状腺肿和可触及的胸骨肿块而被转诊到我们的甲状腺外科诊所。他在临床上看起来很好，颈前肿块增大，胸骨肿块可见，没有淋巴结肿大.实验室检查显示促甲状腺激素水平在正常范围内（2.13mIU/L），FT4轻度降低(10.3pmol/L)。颈部/胸部CT显示多结节性甲状腺肿伴胸骨后延伸，胸骨的膨胀性溶解性病变，和双侧肺转移。甲状腺细针穿刺及细胞学检查显示为FLUS,胸骨病变的真实切割活检显示有侵袭性FTC。
结论：罕见的双侧FTC表现为缓慢增长的胸骨转移。患者接受了甲状腺全切除术，其次是高剂量RAI治疗，结论使用包裹在脯氨酸网状物中的聚甲基丙烯酸甲酯进行胸骨切除和重建手术修复。关于后续行动，他接受了进一步的RAI消融治疗,并变为RAI难治性.然后他接受了全身治疗（Lenvatinib）。最近的随访表明，该疾病得到了控制（低体积癌症），他对治疗的耐受性很好，没有报告症状。
结论：双侧FTC伴胸骨转移少见，可以进行甲状腺全切除术,子宫切除和重建，然后是RAI治疗和需要的全身治疗，因此推断真正的生存利益。
方法：一名43岁的埃及男性胸闷，咳嗽,呼吸急促.他最初被治疗为支气管哮喘。稍后，他因甲状腺肿和可触及的胸骨肿块而被转诊到我们的甲状腺外科诊所。他在临床上看起来很好，颈前肿块增大，胸骨肿块可见，没有淋巴结肿大.实验室检查显示促甲状腺激素水平在正常范围内（2.13mIU/L），FT4轻度降低(10.3pmol/L)。颈部/胸部CT显示多结节性甲状腺肿伴胸骨后延伸，胸骨的膨胀性溶解性病变，和双侧肺转移。甲状腺细针穿刺及细胞学检查显示为FLUS,胸骨病变的真实切割活检显示有侵袭性FTC。
结论：罕见的双侧FTC表现为缓慢增长的胸骨转移。患者接受了甲状腺全切除术，其次是高剂量RAI治疗，结论使用包裹在脯氨酸网状物中的聚甲基丙烯酸甲酯进行胸骨切除和重建手术修复。关于后续行动，他接受了进一步的RAI消融治疗,并变为RAI难治性.然后他接受了全身治疗（Lenvatinib）。最近的随访表明，该疾病得到了控制（低体积癌症），他对治疗的耐受性很好，没有报告症状。
结论：双侧FTC伴胸骨转移少见，可以进行甲状腺全切除术,子宫切除和重建，然后是RAI治疗和需要的全身治疗，因此推断真正的生存利益。
