Endocrine Abstracts

Introduction: Differentiated thyroid carcinoma (DTC) rarely represents with distant organ metastasis. Cerebral metastasis is seen in 0.4–1.2% of patients with distant organ metastasis. There are only 14 patients of DTC with pituitary metastasis reported in the literature. Here, we report a papillary thyroid carcinoma (PTC) patient represented with pituitary metastasis.

Case: A 68-year-old male patient has admitted to our hospital with a growing tumour on his anterior chest wall. On imaging there was a 5 cm mass on the manubrium sterni. The patient was referred to our clinic as the biopsy of the mass revealed PTC metastasis. During clinical evaluation there was 5 cm hypoecoic, hypervascular nodule on left thyroid lobe. Also, there were high fluorodeoxyglucose (FDG) affinity on pituitary region, thyroid left lobe, sternum, first lumber vertebrae and left humerus on positron emission tomography–computerized tomography (PET–CT) consistent with metastasis. Total thyroidectomy with lymph node dissection was performed and pathology revealed poorly differentiated insular type PTC. The pituitary lesion was also operated but could only be partially resected. The pituitary pathology showed PTC metastasis. The sternal mass could not be operated due to high morbidity and invasiveness. Radio-frequency ablation was performed but the mass was continued grow. After 3 months arterial embolisation was performed to the lesion. As the pituitary lesion was very close to the brain stem structures, radio-iodine treatment was decided to be contraindicated. 36 Gy conventional radiation therapy was given to the pituitary region. During all these treatment procedures sorafenib 2×400 mg/day medical treatment was also initiated. He is still as follow up with stable disease.

Result: The pituitary metastasis of PTC is a rare entity. The management strategy of distant organ metastasis of PTC should include multidisciplinary approach.