Metastases in daily endocrine practice

We aim at introducing a series of three cases with different types of malignancy spreading that needed an endocrine check-up. A 70-year old female has come to our attention in order to be evaluated for a prior thyroid cancer. She was previously diagnosed with a parietal lump of 2 cm. Surgery was performed and the pathological report pointed out a skin metastasis from follicular and solid variant of papillary thyroid cancer. Total thyroidectomy with local lymph nodes resection was followed by 100 mCi of 131I radioiodine treatment and suppressive therapy with L-thyroxin. After 6 years of disease-free interval she accused breathing difficulties. CT (computed tomography) showed pulmonary bilateral nodes of 2 cm. Their biopsy confirmed metastases from prior cancer in addition to high thyreoglobulin (Tg) of 300 ng mL which required intense radioiodine treatment and close follow-up. A 62-year old prior smoker female had a total thyroidectomy 3 years ago for papillary thyroid cancer with follicular variant. 131I radio-iodine therapy was added to levothyroxine suppressive treatment. One year after, imagery scan detected multiple right pulmonary lumps. Post-operative histological report confirmed a primitive lung adenocarcinoma. Radiotherapy and chemotherapy were continued while Tg remained low of 0.2 ng mL. A 56-year old female was admitted for adrenal tumours assessment. Two years prior she was diagnosed with a non-secretory left adrenal tumour. During follow-up, a unilateral breast carcinoma was identified and treated. During follow-up, two left tumours and another right one were confirmed, potential spreading of mammary condition. The patient continued chemotherapy for the moment.

Conclusion: Metastases of endocrine glands, even rare, represent a challenging field requiring a good inter- and trans-disciplinary approach. Abbreviations: CT = computed tomography, cm = centimeter, FVPTC = follicular and solid variant of papillary thyroid cancer, PET CT = Positron Emission Tomography, TSH = Thyroid Stimulating Hormone, Tg = thyreoglobulin TgAb = anti-thyreoglobulin antibodies.