Endocrine Abstracts

Sarcoïdosis is a relatively frequent systemic disease of unknown origin. Prevalence is about 4.7–64 in 100 000. We report the case of a 53-year-old woman followed in our institution since 2007 for a thyroid carcinoma. In 2010, she was diagnosed refractory thyroid carcinoma because of a high thyroglobulin assay (477 μg/l) without uptake on post-therapeutic (¹³¹I) whole body scan. Thereafter, the story is marked by the appearance in 2011 of multiple cervical and mediastinal lymph nodes, pulmonary and bones lesions. Bones lesions were treated with surgery, additive radiation therapy and cementoplasty. Between 2011 and 2013, we observed pulmonaries lesions progression with an aspect of lymphangitic carcinomatosis. In early 2013, morphologic evaluation showed the appearance of multiple lymph nodes (hepatic hilum, inguinal bilaterally). Biologically, we noted a slight increase of thyroglobulin assay (711 μg/l). In May 2013, a tyrosine kinase inhibitor, Sorafenib 400 mg twice a day was started. Six months later, a therapeutic evaluation was performed. TEP–TDM showed a majoration of mediastinal, abdominal, and inguinal lymph nodes and pulmonary lesions uptakes (SUV max 12.8) and an intense splenic uptake. Biologically, thyroglobulin assay remained paradoxically stable (673 μg/l). Because of this atypical presentation for a thyroid metastasis disease (lymphangitic carcinomatosis, unusual splenic metastasis, and stable thyroglobulin assay) and past history of breast cancer, a biopsy of a left inguinal lymph node was finally performed. Histological analysis demonstrated an aspect of epitheloid cell granuloma reaction with no caseous necrosis. This aspect was consistent with the diagnosis of sarcoidosis. Sorafenib was discontinued and a corticotherapy was started, enabling an improvement of respiratory symptoms. TEP–TDM performed in April 2014 showed a disappearance of all lymph nodes, pulmonaries, and splenic uptakes. In conclusion, sarcoidosis should be considered in case of atypical thyroid metastatic disease, when presentation is consistent with this diagnosis.