Endocrine Abstracts

Introduction: Based on cancer registries, the risk of second primary malignancies in patients with DTC increases by 30%. In our case report we aimed at understanding the patomechanism of metachronous primary tumours in patients with thyroid cancer.

Case: In a 71-year old female surgery of nodular goitre (1988), followed by papillary thyroid cancer (pT3NxMx) surgery (2008) and complementary 131-I treatment (2009), were performed. In diagnostic WBS (2010) no pathologic 131-I uptake and no enlargement of lymph nodes were stated. Tg concentration after rhTSH stimulation was 10.7 ng/ml. Consecutive 131-I therapy followed (2010). Endometrial cancer, pT1cNxMx, was surgically removed (2011), followed by tele- and brachytherapy. In 2012 a small left kidney tumour and a tumour in the lower left lung were seen in her chest CT. Following nephrectomy, clear cell cancer infiltrating the capsula was established. Resection of lower lobe of left lung followed (2013) and found to be endometrial cancer metastasis. The patient underwent chemotherapy (6 paclitaxel and carboplatin cycles, 2013). Due to increase in thyroglobulin concentration, WBS was performed (2014), with no pathologic 131-I uptake, rhTSH-stimulated TSH (351.9 uU/ml) and Tg (13.8 ng/ml). PET/CT showed 18F-FDG accumulation in a pituitary tumour (SUVmax 21.7). A large (40×30×45 mm) intra- and extrasellar tumour was confirmed in brain CT, with penetration of cavernous sinuses and compression of optic chiasm and inferior frontal gyri. A wait-and-watch strategy was suggested by consulting neurosurgeon due to multiple malignancy, with emergency neurosurgery if necessary. No pathologic mutations were found in AIP, MEN1, p53, PTEN and CHEK2 genes. Diagnostic follow up for pituitary tumour is under way.

Conclusions: To elucidate the genetic background of metachronous neoplasms, molecular screening is necessary. Due to possible concurrence of melanoma, breast, prostate or kidney cancer with thyroid cancer, careful screening of the neck of patients with such tumours is recommended.