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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2023; 06(01): 062-066
DOI: 10.1055/s-0042-1758122
Case Report

Rare Columnar Cell Variant Papillary Thyroid Carcinoma with Metastasis to Pancreas and Lungs at Initial Presentation: A Case Report and Review of Literature

Albert Gjeluci
1   Department of Radiology, Loyola University Medical Center, Maywood, Illinois, United States
,
Joseph Clark 
2   Department of Medical Oncology, Loyola University Medical Center, Maywood, Illinois, United States
,
Anugayathri Jawahar
1   Department of Radiology, Loyola University Medical Center, Maywood, Illinois, United States
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Abstract

Papillary thyroid cancer (PTC) is the most common endocrine malignancy, accounting for 85% of differentiated thyroid cancers. A small percentage of PTC variants are considered more aggressive, such as the tall cell variant associated with the V600E mutation in the BRAF gene and the rarer columnar variant, which is described in only 0.2% of cases and has a poor prognosis. Although locoregional metastases to neck lymph nodes are common, distant metastases of PTC are rare at presentation with only 5 to 7% reported in the literature. We present a very rare case of columnar cell variant PTC with synchronous metastasis to the lungs and indolent focus in the pancreas at initial diagnosis, which has never been reported in the literature. Our patient presented with non-radioactive iodine (RAI) responsive PTC with diffuse metastases to the lungs and one synchronous focal metastatic lesion in the pancreas. After multidisciplinary discussions, pancreatectomy/metastasectomy was deferred due to the disseminated PTC with multiple metastases to the lungs, lack of pancreas-related symptoms in the patient, and inherent complication risks. The patient was treated with systemic therapy using a tyrosine kinase inhibitor (lenvatinib), which is the standard of care for non-RAI responsive PTC and showed a complete radiologic resolution of the pancreatic lesion, however, with partial yet nonprogressive metastatic disease in the lungs.

Keywords

papillary thyroid cancer - columnar cell variant - pancreatic thyroid metastasis - PTC metastases

Note

This study received funding in the form of imaging equipment. The patient described in the manuscript was from the Department of Radiology, Loyola University Medical Center, Maywood, IL, USA. The pathology examination was from the Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.




Publication History

Article published online:
30 December 2022

© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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