Endocrine Abstracts

Introduction

The close relationship between cancer and thrombotic phenomena has been widely recognized and paraneoplastic organ infarctions may occur. Reports of papillary thyroid cancer associated to paraneoplastic phenomena are particularly scarce.

Case report

A 39-year-old man with no prior relevant medical history was evaluated for acute onset of fever, malaise and mild pain referred to his left hypochondrium. He had no clinical suspicion of infection or alterations on the complete blood count, but had an elevation of serum C-reactive protein (75.4 mg/l). His abdominal ultrasound was suggestive of splenic infarction. Despite reporting no history of intravenous drug use nor having any other obvious entrance point, the main initial diagnostic suspicion was infective endocarditis. Blood culture sets were sterile. Transthoracic echocardiogram and transesophageal echocardiogram were both negative for infective endocarditis. The patient underwent a further pro-thrombotic study which also revealed no abnormal results. Thoraco-abdominopelvic CT scan confirmed the splenic infarction with no other abnormal findings except for a contrast-enhanced nodular lesion on the right lobe of the thyroid gland. Ultrasound thyroid evaluation revealed an EU-TIRADS category 5 thyroid nodule measuring 19 × 21 × 28 mm. Fine needle aspiration cytology revealed a Bethesda category VI pattern. His thyroid function tests and calcitonin levels were within normal range. A total thyroidectomy was performed and confirmed the presence of a classical variant of papillary carcinoma. Lymph node metastasis in the central compartment were documented (T2N1Mx). The patient then underwent radioiodine ablation with 100 mCi. At last follow-up evaluation (about 6 months after radioiodine ablation) he met criteria for an indeterminate biochemical response (thyroglobulin 0.7 ng/ml).

Discussion

Splenic infarctions with no obvious cause are frequently attributed to endocarditis but a paraneoplastic etiology must always be discarted. In our case, a papillary thyroid carcinoma with nodal metastasis was found and assumed to be linked to this rare paraneoplastic feature. To our knowledge, this case represents the first report of organ infarction associated with a differentiated thyroid cancer. When evaluating patients with thrombotic events with no other recognizable cause, our case reinforces the need for searching occult tumors that should include the thyroid gland.