Session: SAT 270-310-Thyroid Neoplasia (posters)
Poster Board SAT 308
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
Nothing to Disclose: MNA, TAE, HR, AAA, MIB, HNA
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