Malignant Pleural Metastases in Thyroid Cancer Patients

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 308
Mohammed NMN Ahmed*1, Tarek Abbas Elsayed2, Hussein Raef2, Abdulraof Ahmed Almahfouz2, M Imran Butt2 and Hindi Nasser Alhindi2
1King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Background: There is limited information available regarding malignant pleural effusion (MPE) in thyroid cancer (TC) pts. It is a serious and rare encounter. It is reported to complicate the clinical course in 0.6% of TC pts. (1). We have presented previously (2,3) our experiences at these meetings  in 16 subjects with MPE  representing 0.58% of our thyroid cancer pts. We now extend the data in additional 3 cases to define their clinical, histopathological findings, and to help understand the natural history of TC complicated by MPE. 

Design: A retrospective longitudinal study in the setting of a tertiary care center.

Materials & Methods: A review of their charts & computerized clinical imaging, histopathological, pleural fluid /Bx data, local & systemic therapy given along with their FU information.   

Clinical Case: There were 2 males and one female, their ages ranged 52-65 yrs. Pts. underwent total thyroidectomy and bilateral neck dissection followed by I131 Rx, and LT4 suppression. At initial surgery tumors were locally aggressive papillary thyroid carcinomas (PTC), had capsular/vascular/ extensive lymph nodes invasion. Tumors were multifocal ranged 2-4.3 cm in size. At diagnosis of pleural metastases, pulmonary metastases had progressed extensively, along with disseminated skeletal involvement. In view of persistent pulmonary and skeletal metastases (positive I131 scans and persistently abnormal thyroglobulin, ranged 959->5000 ug/l; negative Tg antibodies) 2 pts. received fairly aggressive therapy consisting of several session of I131Rx and XRT.

Additional data: Pt. #1. received cumulative dose of 580 mCi radioactive iodine, and XRT, followed by sorafenib for 10 months with  little overall positive impact. Pleural effusion was bilaterally massive. It was evident 7 years post diagnosis of TC. PTC was identified in pleural tap fluid, along with numerous psammomma bodies, Symptomatic Pleural effusion was managed by fluid aspiration, pleurodesis using bleomycin without recurrence. He is alive at 84 months follow up.

Pt. #2. received 988 mCi radioactive iodine and XRT. MPE was evident 2 months post diagnosis PTC. Of interest was the observation that persistent pleural effusion resolved 4 months following I131Rx only to recur as minimal loculated effusion. However, she died after a follow up period of 72 months

Pt. #3. Presented with a large unilateral pleural effusion. Following pleural tap, pleural biopsy was done with demonstration of PTC. He is alive at a follow up of 5 months, and awaiting treatment completion

Conclusion: Malignant pleural effusion complicates the clinical course in 0.6% patients with papillary thyroid cancer. It may be the presenting feature or may develop many years after the initial diagnosis but is a grim prognostic indicator. Limited experience with targeted therapy using sorafenib is reported to be effective (4) but our experience was disappointing

References:1. Vassilopoulou-Sellin R1, Sneige N. Pleural effusion in patients with differentiated papillary thyroid cancer. South Med J 1994; 87: (11): 1111-62. M. Ahmed, A Alarifi, A Almahfouz, H Raef, M Khalid, F AlDayel.  Malignant Pleural Involvement in Patients with Thyroid Cancer.  Presented at the 82nd Annual Meeting of the Endocrine Society, Toronto, 21-24 June 20003. Mohammed Ahmed, Al-Amro B, Al-Araj A, Raef H, Al Mahfouz A, Al-Dayal F. Malignant. Pleural Metastases in Thyroid Cancer Patients. Presented at 92nd Annual Endocrine Society Meeting, San Diego California, 19-22 June 20104. Liu M, Shen Y, Ruan M, Li M, Chen L. Notable decrease of malignant pleural effusion after treatment with sorafenib in radioiodine-refractory follicular thyroid carcinoma. Thyroid. 2014 Jul;24(7):1179-83. doi: 10.1089/thy.2013.0703. Epub 2014 May 9

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