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A Journal on Surgery

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Chirurgia 2006 December;19(6):439-41

language: English

Lung metastases from thyroid cancer found 45 years after a right hemithyroidectomy

Kikuchi R. 1, Isowa N. 1, Tokuyasu H. 2, Fukuda K. 2, Kawasaki Y. 2

1 Division of Thoracic Surgery, Matsue Red Cross Hospital, Shimane, Japan
2 Division of Respiratory Medicine, Matsue Red Cross Hospital, Shimane, Japan


The patient was an asymptomatic 73-year-old woman. At the age of 28, she had undergone a right hemithyroidectomy with radical neck dissection for a papillary carcinoma at our hospital, and subsequently postoperative radiotherapy was performed onto the ipsilateral neck. She had quit attending her follow-ups in our hospital several years after the initial treatment. In July 2003, she was referred to our hospital for further investigation of an abnormal shadow on routine mass screening examination. A chest computed tomographic (CT) scan demonstrated a well-demarcated nodule in the right lower lobe. A transbronchial biopsy with flexible bronchoscopy failed to provide a histological diagnosis. Thallium scintigraphy demonstrated an abnormal accumulation at the nodule, highly suggestive of malignancy. We therefore performed video-assisted thoracoscopic fine needle aspiration biopsy to obtain a definitive diagnosis. The intraoperative cytological analysis revealed adenocarcinoma cells, and we performed a right lower lobectomy with mediastinal lymph node dissection, because the development of a solitary pulmonary metastatic lesion from thyroid cancer more than forty years after the primary treatment is extremely rare. However, the final pathological diagnosis was multiple pulmonary metastases from thyroid cancer. To our knowledge, this interval is the longest reported period between initial treatment and radiographically positive pulmonary metastases.

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