Symptomatic Malignant Pleural Effusion in a Case of Metastatic Papillary Thyroid Cancer

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 459-496-Thyroid Neoplasia & Case Reports
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-494
Vafa Tabatabaie*1 and Martin I Surks2
1Montefiore Medical Center, Bronx, NY, 2Montefiore Med Ctr, Bronx, NY
Introduction: Papillary thyroid cancer is generally an indolent disease that infrequently metastasizes to lung and bone. Although pleural involvement with papillary thyroid cancer can happen in the context of pulmonary metastases, symptomatic pleural effusion due to papillary cancer is rare and is associated with significant morbidity and worsening survival: in a series from MD Anderson (1) prevalence of malignant pleural effusion diagnosed during the lifetime was reported as 0.6% among more than 1700 patients with papillary thyroid cancer. 

Case Presentation: We present the case of a 70 year old woman who underwent thyriodectomy in Feb 2012 after FNA of a 5.5 cm left thyroid nodule was positive for papillary thyroid cancer. Two weeks after thyroidectomy, wide-spread spinal metastases were diagnosed on MRI done to evaluate persistent back pain. Laminectomy of T12 vertebra was consistent with metastatic papillary thyroid cancer. While undergoing palliative external radiation therapy, a CXR done for evaluation of shortness of breath revealed massive left pleural effusion which was positive for metastatic papillary cancer. Due to rapid re-accumulation of pleural effusion, she underwent pleurodesis a month later. Seven months after the initial thyroidectomy she received 200mCi of radioactive iodine after thyrogen stimulation but unfortunately no uptake was seen on her post-therapy body scan. She died 3 weeks later.

Discussion: Despite the benign nature of most cases of well-differentiated thyroid cancer, presence of distant metastasis is a clear indication for need for more aggressive management; however, patients with malignant pleural effusion continue to have poor prognosis.

1- Vassilopoulou-Sellin R, Sneige N, Pleural Effusion in Patients with Differentiated Papillary Thyroid Cancer. South Med J;1994, 87: 1111-6.

Nothing to Disclose: VT, MIS

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