Tuberc Respir Dis.  2007 Aug;63(2):188-193. 10.4046/trd.2007.63.2.188.

A Case of Pleural Metastasis from Papillary Tthyroid Carcinoma

• Jeong J
• Shin SY
• Son MK
• Lee YJ
• Kim SH
• Kie JH
• Choi YJ
• Hong YK
• Hahn CH
• Lee SM
• Kim CJ

• KMID: 1910099
• DOI: http://doi.org/10.4046/trd.2007.63.2.188

Abstract

Lung cancer, breast cancer and lymphoma are the common oncologic causes of malignant pleural effusion, comprising more than the half of the causes. However, an endocrinologic carcinoma associated malignant effusion is very rare. Recently, we encountered a case of papillary thyroid carcinoma causing malignant effusion. An 83-year-old female patient presented with dyspnea due to massive pleural effusion in her left side. The pleural biopsy, pleural fluid cytology and breast needle aspiration biopsy results were consistent with a metastatic papillary thyroid carcinoma. Thyroid ultrasonography showed two thyroid masses, but the patient refused a thyroid biopsy. This case highlights the need for considering the possibility of papillary thyroid carcinoma when the cause of malignant pleural effusion cannot be found because one of the rare clinical manifestations of a papillary thyroid carcinoma can be dyspnea due to malignant effusion.

Keyword

Papillary thyroid carcinoma; Pleural metastasis; Malignant pleural effusion

MeSH Terms

Aged, 80 and over
Biopsy
Biopsy, Needle
Breast
Breast Neoplasms
Dyspnea
Female
Humans
Lung Neoplasms
Lymphoma
Needles
Neoplasm Metastasis*
Pleural Effusion
Pleural Effusion, Malignant
Thyroid Gland
Thyroid Neoplasms
Ultrasonography

Figure

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  Figure 1 Chest X-ray shows left pleural effusion and left upper mediastinal mass with tracheal deviation.

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  Figure 2 Chest CT shows a highly enhancing left thyroid mass with central low density (A), enlarged left axillary lymph node (large arrow) and pleural effusion with enhanced pleural nodule (small arrow) (B), and large left anterior chest wall mass with lung invasion (large arrow) and pleural nodules (small arrows) (C).

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  Figure 3 Thyroid ultrasonography shows isoechoic mass measuring 1 cm in the right thyroid (A), and large well-defined isoechoic mixed mass measuring 4.5 cm in the left thyroid (B).

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  Figure 4 On Hematoxylin and Eosin (H&E) stained tissue section of the pleural biopsy specimen, a few papillary clusters of atypical cells with abundant eosinophilic cytoplasm, prominent nucleoli, and occasional nuclear grooves are observed (H&E stain, × 400).

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  Figure 5 On Pap smear of breast aspiration specimen, many papillary clusters of atypical cells are noted (A) (Papanicolaou, ×40). On high power, the atypical cells show occasional nuclear grooves (dotted line) and pseudoinclusion (solid line) (B) (Papanicolau, ×400).

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  Figure 6 On TTF-1 stain of pleural biopsy specimen, the tumor cells show weak positivity to TTF-1 (A)(×200), and breast aspiration specimen showed strong positivity to TTF-1 (B)(×200).

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