Category: Thyroid

Monitor: 22

22 - De Novo Papillary Thyroid Cancer with Pancreatic Metastases

Thursday, Apr 25
12:00 PM – 12:30 PM

Objective : The most common sites of metastases in papillary thyroid cancer (PTC) are the lungs and skeletal system; less common sites are the brain, kidneys, liver and the adrenals.  Pancreatic metastases from PTC are an unusual finding. We are reporting a rare case of a PTC with pancreatic metastases.


Methods : A 75 y.o. gentleman presented with a growing lesion in his left gingiva. Biopsy of the mass showed an undifferentiated pleomorphic sarcoma of the sinonasal tract. Subsequent CT scan revealed a large mass in the right lobe of his thyroid gland along with multiple enlarged cervical lymph nodes. The pathology from both the thyroid mass and cervical lymph node was consistent with PTC. NGS was positive for Braf V600E exon 15 mutation, a Tp53 mutation and a PIK3CA mutation. Further CT scan imaging showed innumerable bilateral pulmonary nodules but no pancreatic lesions. PET-CT scan, however, showed a highly suspicious solitary focus in the tail of the pancreas. Biopsies acquired from the pancreatic mass and the pulmonary nodules confirmed metastases from PTC. By that time, the patient had undergone resection of the gingival sarcoma with negative margins, and completed proper adjuvant radiation therapy with no need for further intervention from that perspective. He, afterwards, underwent thyroidectomy and radioactive iodine ablation.  Subsequent CT imaging, however, showed progression of the PTC metastases, and occurrence of more lesions suspicious for malignancy in the liver and the adrenals. Palliative radiation therapy was commenced. Tumor PD-L1 was found to be 90% expression and the patient received one dose of Pembroluzimab; nonetheless, he continued to deteriorate clinically and passed away soon after, within less than a year since the PTC was first detected.


Results : n/a


Discussion :

Davidson et al, in 2017, reviewed available literature and found only 11 cases of pancreatic metastases in patients with diagnosed PTC since 1991. The average time from detection of the primary PTC to diagnosis of pancreatic metastases was 7 years on average (with a wide range of 1 month to 13 years). We present an unusual occurrence of PTC with metastasis to the pancreas as denovo at the time of diagnosis that was associated with a rapid demise. Mutahir et al described pancreatic metastases diagnosed with PET-CT scan 7 years after total thyroidectomy and radioactive iodine ablation for a PTC. The patient underwent pancreaticoduodenectomy and survived 32 months after detection of the pancreatic metastases.


Conclusion :

Although PTC is a relatively common endocrinologic malignancy, concurrent distant metastases are unusual. Pancreatic metastases are even more rare; and more so, when they occur at the time of diagnosis.

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Leen Alkhouli

Resident physician
UIC/Advocate Christ Medical Center
Burr Ridge, Illinois

Leen Alkhouli, M.D., Internal Medicine resident physician at UIC/Advocate Christ Medical Center

Nancy Guirguis

Resident Physician
UIC/Advocate Christ Medical Center

Nancy Guirguis, M.D., resident physician at UIC/Advocate Christ Medical Center

Bassem Chaar

Hematology/Oncology physician
Advocate Christ Medical Center

Bassem Chaar, M.D., hematology/oncology physician at Advocate Christ Medical Center

Joumana T. Chaiban

Associate Professor of Clinical Medicine; Internal Medicine Residency Program Research Director
University of Illinois at Chicago; Advocate Christ Medical Center, Department of Internal Medicine, Endocrinology Division

Dr. Chaiban is an attending endocrinologist at UIC/Advocate Christ Medical Center. She teaches UIC/ACMC internal medicine residents as well as UIC endocrinology & metabolism fellows from UIC. She also serves as the research director for the internal medicine residency at UIC/ACMC.

Leen Alkhouli

Resident physician
UIC/Advocate Christ Medical Center
Burr Ridge, Illinois

Leen Alkhouli, M.D., Internal Medicine resident physician at UIC/Advocate Christ Medical Center