Endocrine Abstracts

Background: Thyroid carcinoma consists of just 1% of all malignancies but is the commonest malignant endocrine tumour. Papillary thyroid carcinoma is the most common form of thyroid carcinoma consisting of 80% of all cases. There are very few case reports in the literature of papillary thyroid cancers presenting with distant to the pelvic organs. Distant metastases are noted in 1–3% of patients with thyroid cancer at initial diagnosis.

Clinical case: A 69-year-old woman was diagnosed with metastatic papillary thyroid carcinoma, having presented with post-menopausal vaginal bleeding. She had a total thyroidectomy with histology showing papillary thyroid carcinoma pT3N1b with maximum tumour diameter of 70 mm. She then underwent a Total Abdominal Hysterectomy (TAH) and Bilateral salpingo-oophorectomy (BSO). The resected histology showed metastatic papillary thyroid adenocarcinoma in the uterus measuring 2.9 cm × 2.4 cm. Finally, the patient was then treated with radioactive iodine (RAI). No evidence of disease was detected during follow up, until 2 years later, the patient re-presented with further episodes of vaginal bleeding. On internal pelvic examination, a vaginal polyp was visualized and a biopsy showed metastatic papillary thyroid carcinoma. Subsequent CT Thorax Abdomen Pelvis (TAP) showed a vaginal vault lesion, left adnexal mass (4.4 cm × 4 cm) as well as right paratracheal lymph nodes (the biggest measuring 1.4 cm). The patient received 50.4Gy in 28 fractions of EBRT followed by 5500 MBq of RAI. Her post-therapy whole body iodine uptake scan showed no iodine-avid metastases with no residual functioning thyroid tissue. Her post-therapy PET scan showed complete remission of her disease recurrence following the EBRT and RAI.

Conclusion: Papillary thyroid carcinoma presenting initially with distant pelvic metastases makes this case rare. However, the complete remission of the disease recurrence with the use of EBRT and RAI makes this case truly remarkable.