ECE2018 Poster Presentations: Thyroid Thyroid cancer (88 abstracts)
Brain metastases from papillary thyroid carcinoma, 31 years later
Diana Catarino 1 , Joana Saraiva 1 , Cristina Ribeiro 1 , Diana Oliveira 1 , Diana Martins 1 , Adriana Lages 1 , Mara Ventura 1 , Nelson Cunha 1 , Lúcia Fadiga 1 , Bernardo Marques 2 , Sara Donato 3 , Miguel Melo 1 , Maria Corbal 4 , Inácio Reis 5 & Francisco Carrilho 1
1Department of Endocrinology, Coimbra Hospital and University Center, Coimbra, Portugal; 2Portuguese Oncology Institute, Coimbra, Coimbra, Portugal; 3Portuguese Oncology Institute, Lisbon, Lisboa, Portugal; 4Radioterapy Department, Coimbra Hospital and University Center, Coimbra, Portugal; 5Neurocirurgy Department, Coimbra Hospital and University Center, Coimbra, Portugal.
Introduction: Papillary thyroid carcinoma (PTC) is a differentiated thyroid carcinoma and is the most common variant. It is more frequent in women and the median age at diagnosis is 45 years. Most PTC are clinically indolent, have a good prognosis and low incidence of distant metastases. The more frequent locals of distant metastases are bone and lung. Brain metastases are very rare and associated with a poor prognosis.
Case report: We present a case of a 74-years-old woman, without history of radiation and no family history of thyroid disease. In 1984, she underwent a total thyroidectomy with cervical lymphadenectomy. The histologic result was a papillary thyroid carcinoma, with cervical lymph node and pulmonary metastases (T4bN1M1). Between 1984 and 1999, she realized multiple doses of therapeutic radioiodine – I131 (cumulative dose >1Ci). After the last treatment (1999) she realized a post-therapeutic scan that showed no significant uptake (although she maintains pulmonary metastases – clinically indolent). At 2009 she underwent a thoracotomy (nodule with 12 mm). The histologic result was a papillary carcinoma metastase. In 2012 the 18FDG-PET showed bilateral pulmonary metastases with some dedifferentiated lesions. The follow-up showed stable values of thyroglobulin (Tg: 32–57 ng/ml, TgAb: negatives). In November, 2015, she developed a behavior change and realized a cranial CT: frontal lesion with 55×26 mm. December, 2015: she underwent a total excision of the brain lesion; histology: brain metastases from papillary thyroid carcinoma. 18FDG-PET (February, 2016): no hypermetabolic lesions suggestive of dedifferentiated lesions. July, 2016: recurrence of the frontal/temporal brain metastase (50 mm). She realized a second surgery; histology: brain metastase. She underwent holocranian radiotherapy (30Gy) and started Sorafenib (October, 2016). Despite this, there was progression of brain lesions and she developed adverse effects. It was decided stop sorafenib. The patient maintains oncology and neurosurgery visits.
Discussion and conclusion: The present case show that brain metastases, although rare, can occur decades after the diagnosis of papillary thyroid carcinoma. Surgery and radiotherapy are the main therapeutics approach. Tyrosine kinase inhibitors was approved by FDA for the treatment of patients with radioiodine-refractory metastatic thyroid cancer, but the experience is limited. Patients with brain metastases have a poor prognosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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