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Arch Hellen Med, 30(3), May-June 2013, 299-308


Clinical findings of thyroid cancer in 288 Japanese
Early soft tissue and bone metastases with raised serum thyroglobulin (Tg)
in follicular and undifferentiated types

T. Nakatsuji
Department of Transfusion Cell Therapy, Hamamatsu University, School of Medicine, Hamamatsu, Japan

OBJECTIVE Investigation of the clinical findings in 661 Japanese patients with thyroid nodules, of which 288 (44%) were malignant.

METHOD AND RESULTS Of the 288 malignant thyroid nodules, histological examination showed papillary carcinoma (Ca) in 249 (86.5%), follicular Ca in 28 (9.7%), undifferentiated Ca in 4 (1.4%), and medullary Ca in 7 (2.4%). Even among the 104 cases of papillary Ca with normal serum levels of thyroglobulin (Tg) (4−78 ng/mL), microscopic cervical lymph node (CLN) metastases were identified in 84% at thyroidectomy. All 28 cases of papillary Ca with Tg >500 ng/mL showed extra-thyroid metastases, and an anti-Tg antibody level of >=100 U/ mL was detected in 10. High Tg secretion (>10,000 ng/mL) from soft tissue, bone or lung metastases was detected in 9 (32%) cases of follicular Ca and in 2 (50%) of undifferentiated Ca, in which metastatic curettage improved the clinical findings. Tg levels of 4,000−10,000 ng/mL were observed in 7 (25%) cases of follicular Ca and 1 (25%) of undifferentiated Ca. One elderly female with follicular Ca and Tg >10,000 ng/mL developed bone marrow dysplasia with proliferation of p53- and CD163-positive macrophages and peripheral pancytopenia 28.5 years after the diagnosis of thyroid Ca. Patients with follicular Ca with relatively low Tg of <2,000 ng/mL more commonly exhibited early lung metastases. The thyroid Ca, in 12 (4.8%) patients with papillary Ca and 1 (3.6%) with follicular Ca suspected of Cowden syndrome (CS), was associated with bilateral breast Ca, with a good prognosis, apart from 2 cases with high Tg levels (673 and 704 ng/mL).

CONCLUSIONS Thyroid Ca had very early extra-thyroid metastases but a long survival rate.

Key words: Bone, soft tissue metastasis, Breast cancer, Cervical lymph node metastasis, Metastatic cancer activation, Serum thyroglobulin, Thyroid cancer.

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