title: Papillary thyroid cancer with an initial presentation of abdominal and flank pain.
abstract: OBJECTIVE
  Well-differentiated thyroid cancer typically presents as a thyroid mass. Common sites of metastases upon presentation include cervical lymph nodes, lung, and bone. Well-differentiated thyroid cancer with clinically apparent kidney metastases is rare, with fewer than 20 cases reported in the literature. In the vast majority of these cases, the patients had known thyroid neoplasms at the time the renal metastases were identified. We report a case of papillary thyroid carcinoma that presented with abdominal pain in a 25-year-old woman with no previous history of thyroid disease.
  
  
  METHODS
  This study is a case report.
  
  
  RESULTS
  The patient underwent radical nephrectomy for a right renal mass, which was diagnosed as papillary thyroid carcinoma follicular variant. During subsequent evaluation, metastatic disease was also identified in the patient's lungs. The patient was treated with total thyroidectomy and iodine 131.
  
  
  CONCLUSIONS
  Papillary cancer, which ordinarily behaves in an indolent manner, can have unusual presentation, including disseminated metastasis on presentation. Renal metastases are extremely rare.
authors.affiliation: Division of Otolaryngol Head Neck Surg., Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Ruggiero
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Frauenhoffer
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Stack
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology*; D000328:Adult; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D021501:Flank Pain / Q000175:diagnosis*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D016609:Neoplasms, Second Primary; D009392:Nephrectomy; D016634:Radiosurgery; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed