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      An Extremely Rare Case of Thyroid Metastasis from Advanced Gastric Cancer

      case-report
      a , b , c , *
      Case Reports in Oncology
      S. Karger AG
      Gastric cancer, Thyroid gland metastasis, CEA, TTF-1

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          Abstract

          Metastases to the thyroid area are extremely rare in cancer, more specifically, in gastric cancer, where intraperitoneal metastases are absent. Herein, we describe a case of a 41-year-old man who had advanced gastric cancer with metastasis to the right thyroid area, which was found 6 years after curative surgery. The patient presented with multiple enlarged right cervical lymph nodes and a right thyroid mass of 1.2 cm. We assumed that the patient had primary thyroid cancer as he had no signs of other metastases. We performed fine-needle cytology under ultrasonography on the thyroid nodule. However, with a positive carcinoembryonic antigen and a negative thyroid transcription factor 1 immunohistochemical staining results, the patient was diagnosed with metastatic adenocarcinoma that was of gastric origin. Subsequently, the patient was treated with radiotherapy and chemotherapy. This report aimed to raise the concern that gastric cancer may cause metastasis to the peri-thyroid area, involving the thyroid, parathyroid, and regional lymph nodes.

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          Most cited references19

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          Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial.

          Trastuzumab, a monoclonal antibody against human epidermal growth factor receptor 2 (HER2; also known as ERBB2), was investigated in combination with chemotherapy for first-line treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer. ToGA (Trastuzumab for Gastric Cancer) was an open-label, international, phase 3, randomised controlled trial undertaken in 122 centres in 24 countries. Patients with gastric or gastro-oesophageal junction cancer were eligible for inclusion if their tumours showed overexpression of HER2 protein by immunohistochemistry or gene amplification by fluorescence in-situ hybridisation. Participants were randomly assigned in a 1:1 ratio to receive a chemotherapy regimen consisting of capecitabine plus cisplatin or fluorouracil plus cisplatin given every 3 weeks for six cycles or chemotherapy in combination with intravenous trastuzumab. Allocation was by block randomisation stratified by Eastern Cooperative Oncology Group performance status, chemotherapy regimen, extent of disease, primary cancer site, and measurability of disease, implemented with a central interactive voice recognition system. The primary endpoint was overall survival in all randomised patients who received study medication at least once. This trial is registered with ClinicalTrials.gov, number NCT01041404. 594 patients were randomly assigned to study treatment (trastuzumab plus chemotherapy, n=298; chemotherapy alone, n=296), of whom 584 were included in the primary analysis (n=294; n=290). Median follow-up was 18.6 months (IQR 11-25) in the trastuzumab plus chemotherapy group and 17.1 months (9-25) in the chemotherapy alone group. Median overall survival was 13.8 months (95% CI 12-16) in those assigned to trastuzumab plus chemotherapy compared with 11.1 months (10-13) in those assigned to chemotherapy alone (hazard ratio 0.74; 95% CI 0.60-0.91; p=0.0046). The most common adverse events in both groups were nausea (trastuzumab plus chemotherapy, 197 [67%] vs chemotherapy alone, 184 [63%]), vomiting (147 [50%] vs 134 [46%]), and neutropenia (157 [53%] vs 165 [57%]). Rates of overall grade 3 or 4 adverse events (201 [68%] vs 198 [68%]) and cardiac adverse events (17 [6%] vs 18 [6%]) did not differ between groups. Trastuzumab in combination with chemotherapy can be considered as a new standard option for patients with HER2-positive advanced gastric or gastro-oesophageal junction cancer. F Hoffmann-La Roche. Copyright 2010 Elsevier Ltd. All rights reserved.
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            First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial

            First-line chemotherapy for advanced or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric or gastro-oesophageal junction adenocarcinoma has a median overall survival (OS) of less than 1 year. We aimed to evaluate first-line programmed cell death (PD)-1 inhibitor-based therapies in gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma. We report the first results for nivolumab plus chemotherapy versus chemotherapy alone.
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              Metastasis to the thyroid gland. A report of 43 cases.

              The incidence of metastasis to the thyroid gland in autopsy series varies from 1.25% to 24%. Metastasis to the thyroid gland is usually considered a terminal event, and the effectiveness of conventional treatment has been questioned. The authors assessed the effects of current methods of diagnosis and treatment on the course of the disease. Forty-three patients with metastasis to the thyroid gland were studied retrospectively. Primary tumor origin was identified in all but two cases. Metastasis to the thyroid gland was confirmed by fine-needle aspiration cytology or histology. Data were analyzed for the frequency and types of malignant lesions, the clinical course of disease, and the prognosis after thyroid involvement. The kidney was the most common primary tumor site (33%), followed by lung (16%), breast (16%), esophagus (9%), and uterus (7%). The time from diagnosis of the primary tumor to metastasis to the thyroid gland was considerable for renal cell adenocarcinoma (mean, 106 months) and for adenocarcinomas of the breast (mean, 131 months) and uterus (mean, 132 months). In 12 patients, this interval was more than 120 months. Fine-needle aspiration cytology detected metastatic malignancy in 29 of 30 patients. Treatment involved surgery alone, surgery with adjuvant therapy, or nonsurgical methods. Two patients with uterine adenocarcinoma and one with breast adenocarcinoma had disease regression with no evidence of tumor recurrence. In any patient with a previous history of malignancy, no matter how remote that history is, a new thyroid mass should be considered recurrent malignancy until proved otherwise. Although detection of metastasis to the thyroid gland often indicates poor prognosis, aggressive surgical and medical therapy may be effective in a small percentage of patients.
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                Author and article information

                Journal
                Case Rep Oncol
                Case Rep Oncol
                CRO
                Case Reports in Oncology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1662-6575
                Sep-Dec 2022
                27 September 2022
                27 September 2022
                : 15
                : 3
                : 841-847
                Affiliations
                [1] aDepartment of Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
                [2] bDepartment of Internal Medicine, Chung-Ang University Gwangmyung Hospital, Gwang-Myung, Republic of Korea
                [3] cDepartment of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
                Author notes
                Article
                cro-0015-0841
                10.1159/000526572
                9941784
                cc70c72a-3e64-49f9-84f7-6dc8f5f5d389
                Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 21 July 2022
                : 1 August 2022
                : 2022
                Page count
                Figures: 3, References: 15, Pages: 7
                Funding
                There was no funding for this article.
                Categories
                Case Report

                Oncology & Radiotherapy
                gastric cancer,thyroid gland metastasis,cea,ttf-1
                Oncology & Radiotherapy
                gastric cancer, thyroid gland metastasis, cea, ttf-1

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