Diagnosis and treatment of pancreatic metastases of a papillary thyroid carcinoma.
BACKGROUND
Apart from regional lymph node metastases, systemic metastases occur sporadically in papillary thyroid carcinomas (PTC). The lung and bones are the most frequent localizations. Additionally known but extremely rare locations are metastases of the skeletal muscles, ovaries, submandibular gland, sphenoidal sinus, brain, adrenals, and, as shown in only two previously published cases to date, the pancreas.


CONCLUSIONS
In this article we report about two additional patients with pancreatic metastases from PTC. There is almost no prior experience about therapeutic approaches to this type of metastases. In both patients distant metastases within the pancreas were successfully removed. Postoperative histology confirmed the diagnoses. Supplemental genetic analysis did not demonstrate a BRAF V600E mutation or expression of a RET/PTC1 rearrangement in one case, but revealed a BRAF V600E mutation in the second case. Surgery avoided impending complications maintaining quality of life. One patient had a tumor-specific survival of 42 months. The other patient has occult disease.


CONCLUSIONS
Our two patients benefited of a calculated aggressive surgical action. Thus, if low perioperative mortality and morbidity can be warranted, surgical measures are justifiable in selected cases.
Borschitz
Thomas
T
Endocrine Surgery, Clinic of General and Abdominal Surgery, University Medical Center, Gutenberg University Mainz, Mainz, Germany. borschit@mail.uni-mainz.de
Eichhorn
Waltraud
W
Fottner
Christian
C
Hansen
Torsten
T
Schad
Arno
A
Schadmand-Fischer
Simin
S
Weber
Matthias M
MM
Schreckenberger
Mathias
M
Lang
Hauke
H
Musholt
Thomas J
TJ
D000328:Adult; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D049268:Positron-Emission Tomography; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D018714:Radiotherapy, Adjuvant; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D013965:Thyroidectomy; D016896:Treatment Outcome
D003287:Contrast Media; D019788:Fluorodeoxyglucose F18; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf