Endocrine Abstracts

Introduction – aim: The incidence of multiple primary cancers is reported to be between 0.3 and 4.3%. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a period of time (metachronous). We report such a rare occurrence of dual malignancy of the thyroid and brain in order to stress the importance of a good preoperative workup to arrive at such a diagnosis preoperatively and also to stress the importance of radical surgery in patients with operable primary tumors.

Case report: A 47-year- old man was admitted to our Medical center on March 18, 2010 with 4-month history of weakness of the right fingers, with a thyroid mass. Magnetic resonance imaging revealed a mass lesion in the right temporal, frontal lobes of brain with diffuse high intensity on T2-weighted and fluid-attenuated inversion images. A few small lesions were enhanced by contrast medium on the T1-weighted images. Ultrasound examination of thyroid: nodules (size 2.6×2.1×2.0 cm and 5 mm) in the right lobe and 3 nodules (4 mm, 6 mm, 8 mm) in the left lobe. Ultrasonography guided fine-needle aspiration biopsy was performed and the cytological examination revealed cells of papillary thyroid cancer. The absence of familial adenomatous polyposis was determined after a complete colonoscopy. In 24.03.2010 subtotal removal of brain tumor was performed. Histologically the brain neoplasm was astrocytoma grade II. In 5.04.2010 a total thyroidectomy with central and unilateral modified left radical neck dissection was performed. Histology demonstrated a papillary thyroid carcinoma with extrathyroidal extension to parathyroid soft tissue, metastases to the lymph nodes. Postoperatively, he underwent radioactive iodine ablation therapy. In order to explain the molecular basis for such an occurrence, we performed the immunohistochemistry of the operative specimens. The cells thyroid cancer reacted for p53 (reaction +) in 75% sells, Her 2 (+2 in 90% cells), vimentin (+), EMA(+), L-thyroglobulin (+), estrogen receptors – (+), progesterone receptors-(++), pancytokeratin – (++). The astrocytoma was positive only for p53 (+).

Conclusion: In the light of advances in molecular biology we can only conjecture that the mutant p53 which has been found in both papillary thyroid cancers and astrocytomas may be one such putative mutation underlying such an occurrence.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.