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      Thyroid carcinoma with atypical metastasis to the pituitary gland and unexpected postmortal diagnosis

      1 , 1 , 5 , 1 , 1 , 2 , 7 , 2 , 4 , 6 , 3 , 1 , 1 , 1
      Endocrinology, Diabetes & Metabolism Case Reports
      Bioscientifica Ltd
      Adult, Female, White, Poland, Thyroid, Thyroid, Prolactin, FSH, LH, TSH, Thyroid carcinoma, Sarcoidosis*, Papillary thyroid cancer, Metastatic carcinoma, Goitre (multinodular), Pituitary adenoma, Granuloma, Lymphadenopathy, Hyponatraemia, Hypopituitarism, Hyperprolactinaemia, Heart failure, Ventricular fibrillation, Sarcoidosis, Goitre, Headache, Diplopia, Dizziness, Paraesthesia, Ptosis, Visual impairment, Vision - acuity reduction, Oculomotor nerve palsies*, Vomiting, Hyponatraemia, Normochromic normocytic anaemia, Lymphadenitis, Hyperprolactinaemia, Hypopituitarism, Fine needle aspiration biopsy, Histopathology, MRI, Pituitary function, Prolactin, CT scan, Immunohistochemistry, Thyroid transcription factor-1, Thyroglobulin, Thyroid ultrasonography, Ultrasound scan, FSH, LH, TSH, Radionuclide imaging, Cytokeratin 7*, Thyroid antibodies, Lymph node dissection, Thyroidectomy, Transsphenoidal surgery, Resection of tumour, Levothyroxine, Dopamine agonists, Bromocriptine, Mineralocorticoids, Sodium chloride, Hydrocortisone, Glucocorticoids, Corticosteroids, Recombinant TSH*, Surgery, Unique/unexpected symptoms or presentations of a disease, March, 2020

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          Papillary thyroid gland carcinoma is the most common type of malignancy of the endocrine system. Metastases to the pituitary gland have been described as a complication of papillary thyroid cancer in few reported cases since 1965. We report the case of a 68-year-old female patient with a well-differentiated form of thyroid gland cancer. Despite it being the most common malignant cancer of the endocrine system, with its papillary form being one of the two most frequently diagnosed thyroid cancers, the case we present is extremely rare. Sudden cardiac arrest during ventricular fibrillation occurred during hospitalization. Autopsy of the patient revealed papillary carcinoma of the thyroid, follicular variant, with metastasis to the sella turcica, and concomitant sarcoidosis of heart, lung, and mediastinal and hilar lymph nodes. Not only does atypical metastasis make our patient’s case most remarkable, but also the postmortem diagnosis of sarcoidosis makes her case particularly unusual.

          Learning points:
          • The goal of presenting this case is to raise awareness of the clinical heterogeneity of papillary cancer and promote early diagnosis of unexpected metastasis and coexisting diseases to improve clinical outcomes.

          • Clinicians must be skeptical. They should not fall into the trap of diagnostic momentum or accept diagnostic labels at face value. Regardless of the potential mechanisms, clinicians should be aware of the possibility of the coexistence of thyroid cancer and sarcoidosis as a differential diagnosis of lymphadenopathy.

          • This case highlights the importance of the diagnostic and therapeutic planning process and raises awareness of the fact that one uncommon disease could be masked by another extremely rare disorder.

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          Most cited references17

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          Tumors metastatic to the pituitary gland: case report and literature review.

          Tumors metastatic to the pituitary gland are an unusual complication of systemic cancer typically seen in elderly patients with diffuse malignant disease. Breast and lung are the commonest sites of the primary tumor, whereas diabetes insipidus is the most frequent symptom at presentation. Their rarity and usually indolent course, as well as the lack of specific clinical and radiological features, impede their differentiation from other more common sellar area lesions, particularly when history of malignancy is absent. Management of these patients may also be very difficult because the prognosis depends on the course of the primary neoplasm. A 68-yr-old man, with no history of malignancy, presented with recent onset of hypopituitarism, mild diabetes insipidus, headaches, left oculomotor nerve palsy, and progressive bilateral deterioration of visual acuity and visual fields. Magnetic resonance imaging revealed a large sellar mass compressing the optic chiasm and invading the left cavernous sinus, whereas a prolactin elevation at 438.6 ng/ml (19.73 nmol/liter) was noted. Decompression of the sellar region was attempted, and pathology disclosed a metastatic hepatocellular carcinoma. On postoperative investigation, primary liver tumor was identified and confirmed by biopsy. The patient improved transiently but died 3 months after diagnosis because of deterioration of the liver disease. The relevant literature is reviewed in light of this unusual case, illustrating the problems in the diagnosis and management of patients with metastasis to the pituitary.
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            Sarcoidosis and malignancy.

            Malignancy in patients with sarcoidosis occurs in 3 settings. The first setting relates to patients with hematologic malignancies. It includes the sarcoidosis-lymphoma syndrome, which refers to the development of lymphoma at least 1 to 2 years after the diagnosis of sarcoidosis. It also includes patients with sarcoidosis who develop other hematologic malignancies. In addition, this subset of individuals includes patients with cancer and hematologic malignancies who subsequently develop sarcoidosis. The second setting consists of patients with sarcoidosis who develop solid tumors and oncologic patients in whom sarcoidosis subsequently appears; in addition to melanoma and nonmelanoma skin cancer, the neoplasms most commonly associated involve the cervix, liver, lung, testicles, and uterus. The third setting of malignancy-related sarcoidosis occurs when sarcoidosis presents as a paraneoplastic syndrome for the associated cancer, specifically when the discovery of cancer is concurrent with or within 1 year of the diagnosis of sarcoidosis or vis-a-vis. Antineoplastic treatment of either the hematologic malignancy or the solid tumor has also been observed to either induce the initial onset or flare the activity of sarcoidosis. Malignancy can also be associated with the occurrence of sarcoid reactions that typically are restricted to the regional lymph nodes or the visceral organ of tumor origin; rarely, the sarcoid reaction can also be observed in the skin or is only limited to the skin.
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              Management of brain metastases from thyroid carcinoma: a study of 16 pathologically confirmed cases over 25 years.

              Brain metastasis is an uncommon, morbid complication of metastatic thyroid carcinoma. Because of its rarity, management often is problematic. To help contribute to the management of this disease entity, the authors present herein what to their knowledge is the largest series reported to date in which all patients had biopsy proven confirmation of their brain metastases. The authors report a series of 16 patients with metastatic thyroid carcinoma to the brain who were treated between 1976-2000. The Mayo Clinic database was used to locate and review charts and radiology and pathology reports, and all biopsy specimens were reviewed by one pathologist. The histologic types of carcinoma included 10 papillary carcinomas, 2 follicular carcinomas, 1 Hürthle cell carcinoma, 1 medullary carcinoma, 1 insular carcinoma, and 1 anaplastic carcinoma. Given the small sample size, statistical analyses were not performed. Surgical resection of brain metastases was associated with a trend toward longer survival (20.8 months vs. 2.7 months for no surgical intervention in selected patients) Whole brain external beam radiation therapy produced disease regression in three of the four evaluable patients. Gamma knife radiosurgery and radioactive iodine therapy appear to play limited, but beneficial, therapeutic roles. Overall, survival after the diagnosis of brain metastasis is reported to be longer than that noted with other solid tumors (17.4 months), and the majority of patients die of their extracranial disease (85% in the current series). The results of the current study indicate that local therapies appear to control brain metastases in the large majority of thyroid carcinoma patients with metastases to the brain. Copyright 2003 American Cancer Society.

                Author and article information

                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                13 March 2020
                : 2020
                : 19-0148
                [1 ]Departments of Endocrinology , Diabetology and Internal Medicine
                [2 ]Departments of Nuclear Medicine , Medical University of Bialystok, Bialystok, Poland
                [3 ]Departments of Human Anatomy , Medical University of Bialystok, Bialystok, Poland
                [4 ]Departments of Medical Pathomorphology , Medical University of Bialystok, Bialystok, Poland
                [5 ]Radiology , Medical University of Bialystok, Bialystok, Poland
                [6 ]Department of Endocrinology and Radioisotopy Therapy , Military Institute of Medicine, Warsaw, Poland
                [7 ]1st Clinic Department of General and Endocrine Surgery , Medical University of Bialystok, Bialystok, Poland
                Author notes
                Correspondence should be addressed to A Popławska-Kita; Email: annapoplawskakita@ 123456op.pl
                Author information
                © 2020 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                : 03 February 2020
                : 21 February 2020
                Thyroid Carcinoma
                Papillary Thyroid Cancer
                Metastatic Carcinoma
                Goitre (Multinodular)
                Pituitary Adenoma
                Heart failure
                Ventricular fibrillation
                Visual impairment
                Vision - acuity reduction
                Oculomotor nerve palsies*
                Normochromic normocytic anaemia
                Fine needle aspiration biopsy
                Pituitary function
                CT scan
                Thyroid transcription factor-1
                Thyroid ultrasonography
                Ultrasound scan
                Radionuclide imaging
                Cytokeratin 7*
                Thyroid antibodies
                Lymph node dissection
                Transsphenoidal surgery
                Resection of tumour
                Dopamine agonists
                Sodium chloride
                Recombinant TSH*
                Unique/Unexpected Symptoms or Presentations of a Disease
                Unique/Unexpected Symptoms or Presentations of a Disease

                adult,female,white,poland,thyroid,prolactin,fsh,lh,tsh,thyroid carcinoma,sarcoidosis*,papillary thyroid cancer,metastatic carcinoma,goitre (multinodular),pituitary adenoma,granuloma,lymphadenopathy,hyponatraemia,hypopituitarism,hyperprolactinaemia,heart failure,ventricular fibrillation,sarcoidosis,goitre,headache,diplopia,dizziness,paraesthesia,ptosis,visual impairment,vision - acuity reduction,oculomotor nerve palsies*,vomiting,normochromic normocytic anaemia,lymphadenitis,fine needle aspiration biopsy,histopathology,mri,pituitary function,ct scan,immunohistochemistry,thyroid transcription factor-1,thyroglobulin,thyroid ultrasonography,ultrasound scan,radionuclide imaging,cytokeratin 7*,thyroid antibodies,lymph node dissection,thyroidectomy,transsphenoidal surgery,resection of tumour,levothyroxine,dopamine agonists,bromocriptine,mineralocorticoids,sodium chloride,hydrocortisone,glucocorticoids,corticosteroids,recombinant tsh*,surgery,unique/unexpected symptoms or presentations of a disease,march,2020


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