Metástasis pancreática como debut de carcinoma papilar de tiroides. Caso clínico y revisión del perfil clínico patológico y molecular

• Autores: Thomas Uslar, Javier Chahuán, Roberto Olmos, Carolina Rodríguez, Rocio Astudillo, P. Zoroquiain, Antonieta Solar González, Alberto Espino, Augusto León, Carlos Fardella, José M. Domínguez
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 148, Nº. 7, 2020, págs. 1025-1030
• Idioma: español
• Títulos paralelos:
  • Papillary thyroid carcinoma presenting with pancreatic metastases. Report of one case
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• Resumen

  • Pancreatic metastases of papillary thyroid carcinoma (PTC) are exceptional. We report a 80-year-old man consulting for obstructive jaundice and dysphonia. Abdominal ultrasonography showed biliary dilation and abdominal magnetic resonance imaging (MRI) showed a pancreatic head mass of 36 mm. A left vocal cord paralysis was confirmed and cervical computed tomography (CT) showed multiple thyroid nodules of up to 35 mm associated with bilateral cervical lymph nodes (LN). Positron emission tomography ( 18 F-FDG PET/CT) evidenced hyper-metabolic activity in bilateral cervical LN, lungs, pancreas and left intercostal soft tissue, as well as left gluteus. Thyroid biopsy reported a tall-cell variant of PTC, and endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic mass confirmed PTC metastasis. The molecular study was positive for BRAFV600E. Pancreatic metastasis from PTC can be accurately diagnosed with 18 F-FDG PET/CT and EUS-FNA, which is consistent with a predominant expression of BRAFV600E mutation and, thus, an aggressive presentation with poor short-term survival.