Metastatic Carcinoma of the Sigmoid Colon to the Thyroid Gland Yuhei SHIBUTANI 1), Daisuke INOUE 1), Toshihiko YOKOTA 2), Jyoji OKUDA3) and Toru MORI3

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Transcription:

Metastatic Carcinoma of the Sigmoid Colon to the Thyroid Gland Yuhei SHIBUTANI 1), Daisuke INOUE 1), Toshihiko YOKOTA 2), Jyoji OKUDA3) and Toru MORI3) 1) Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital 2) Department of Internal Medicine, Osaka Red Cross Hospital 3) Department of Clinical Laboratory and Medicine, Kyoto University School of Medicine A case of metastatic thyroid cancer from sigmoid colon cancer is presented. A 52-year- old woman had a sigmoidectomy due to adenocarcinoma of the sigmoid colon in April 1988. Serum carcinoembryonic antigen (CEA) levels gradually rose from July 1990 along with multiple metastatic lesions which appeared in the lung. They were resected in January 1991. Two months later the subject noticed a painless and firm lump on the left anterior neck. She was found to have a solitary mass in the left thyroid lobe. Thyroid function remained within normal range. Cytological findings obtained by fine-needle aspiration biopsy showed tall columnar carcinoma cells with an acinar pattern. Subtotal thyroidectomy was performed, and histological examination revealed metastatic adenocarcinoma from colon cancer. Immunohistochemical staining by anti-cea was positive but anti-thyroglobulin was negative. Key words : Thyroid metastasis, Sigmoid colon cancer

Fig. 1 Ba enema showing apple core sign in the sigmoid colon (April 1988). Fig. 2 Histologic section of the tumor in the sigmoid colon showing well-differentiated adenocarcinoma (Hematoxylin and eosin; ~200).

Fig. 3 Chest X-ray showing multiple metastatic lesions in the lung (January 1991). Table 1 Laboratory data on admission

Fig. 4 99mTc - pertechnetate and 201T1- chloride scintiscan of the thyroid. Fig. 5 CT scan of the thyroid showing low density area in the left lobe.

Fig. 6 Fine-needle aspirate from the tumor in the thyroid showing tall columnar carcinoma cells with an acinar pattern (Papanicolaou; ~ 200). Fig. 7 Histologic section showing metastasis from adenocarcinoma of the colon to the thyroid (Hematoxylin and eosin; ~ 200).

770 S状 結 腸 癌 の 甲状 腺 転移 の1例(渋 Fig. 8 谷,他4名) Thyroglobulin (TG) and CEA staining ( x 40). Positive staining for TG is observed in normal thyroid follicles and positive staining for CEA is observed in focus of adenocarcinoma. 考 悪 性 腫 瘍 の剖 検 例 の 検 討 で は,甲 察 状 腺 へ の 転 移 の 頻 度 は1.9-9.5%と 報 告 され て お り1)2)3),あま りめ ず ら しい もの で は な い しか し,臨 床 上 問題 と な る 他 臓 器 原 発 癌 の 甲状 腺 へ の 転 移 は 極 め て 少 な く,Wychulisら の 報 告 ので は,甲 状 腺 の 手 術 症 例20,262例 の 転 移 性 甲 状 腺 腫 瘍58例 の 集 計 に よ れ ば,そ 肺 癌,乳 癌 の 順 と な っ て い る MayoClinicで 中10例(0.05%)で あ っ た Elliottら5) の 原 発 巣 は 腎 癌 が33例 と最 も多 く,次 い で 消 化 器 系 癌, は,1946-1982の36年 間 に30例 の 転 移 性 甲 状 腺 腫 瘍 を 経 験 して お り,原 発 巣 は 同様 に 腎 癌,乳 癌,肺 癌 が 多 く,そ の3疾 患 で 全 体 の7割 以 上(23例)を 占め て い た6) 大 腸 癌 の 甲状 腺 転 移 の 報 告 例 は 少 な く,ま た そ の 原 発 巣 は い ず れ も 直 腸 癌 で あ り4)5)7)8)9)10),本 第68巻 第8号

1) Abrams H.L., Spiro R. and Goldstein N. : Metastases in carcinoma. -Analysis of 1000 autopsied cases. Cancer, 1950; 3: 74-85 2) Mortensen J.D., Woolner L.B. and Bennett W.A. : Secondary malignant tumors of the thyroid gland. Cancer, 1956; 9: 306-309 3) Shimaoka K., Sokal J.E. and Pickren J.W. : Metastatic neoplasms in the thyroid gland: Pathological and clinical findings. Cancer, 1962; 15: 557-565 4) Wychulis A.R., Beahrs 0.H. and Woolner L.B. : Metastasis of carcinoma to the thyroid gland. Ann. Surg., 1964; 160: 169-177 5) Elliott R.H.E. and Frantz V.K. : Metastatic carcinoma masquerading as primary thyroid cancer: A repot of authors' 14 cases. Ann. Surg., 1960; 151: 551-561 6) Ivy H.K. : Cancer metastatic to the thyroid: A diagnostic problem. Mayo Clin. Proc., 1984; 59: 856-859 10) Sklaroff D.M. : Metastatic carcinoma of rectum to the thyroid gland: correlation with radioactive iodine studies. A.M.A. Arch. Surg., 1954; 68: 117-119 12) Willis R.A. : Metastatic tumors in the thyroid gland. Am. J. Pathol., 1931; 7: 187-208 13) Smith S.A., Gharib H. and Goellner J.R. : Fine-needle aspiration: Usefulness for diagnosis and management of metastatic carcinoma to the thyroid gland. Arch. Intern. Med., 1987; 147: 311-312 16) Evans H.L. : Columnar-cell carcinoma of the thyroid. A report of two cases of an aggressive variant of thyroid carcinoma. Am. J. Clin. Pathol., 1986; 85: 77-80

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