Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor of the thyroid gland mostly occurring in young patients. The imaging findings of SETTLE tumors are yet to be defined. However, they are usually described as well-defined heterogeneously enhanced masses on CT scan. The current case has the potential growth as compared with a 2009 chest radiography. We took into account the possibility of SETTLE in the case of a bulky mass in patients over 70 years old, particularly in the lower neck. Herein, we report a case of the oldest patient so far. The patient underwent a right lobectomy of the thyroid and mass excision. Follow-up CT scans after 6 months revealed no local recurrence. Surgery is the gold standard treatment for SETTLE. Chemotherapy and radiotherapy could be another possible option for patients with advanced stage SETTLE.
Aged* ; Drug Therapy ; Follow-Up Studies ; Humans ; Neck ; Radiography ; Radiotherapy ; Recurrence ; Thorax ; Thyroid Gland* ; Thyroid Neoplasms ; Tomography, X-Ray Computed

Anti-programmed cell death-1 (PD-1) humanized monoclonal antibody inhibits PD-1 activity by binding to the PD-1 receptor on T-cells and blocking PD-1 ligands and induces immune tolerance of cancer cells. It has been widely used for various kinds of cancer treatment. However, many immune-related adverse events (irAEs) have been reported because it modulates our immune system. In this case study, we reported a case of 42-year-old woman with Hashimoto's thyroiditis who showed rapid aggravation of thyroid goiter and acute hyperventilation syndrome after treatment with PD-1 inhibitor as a neoadjuvant chemotherapy for breast cancer.
Adult ; Breast Neoplasms ; Breast ; Drug Therapy ; Female ; Goiter ; Humans ; Hyperventilation ; Immune System ; Immune Tolerance ; Ligands ; Programmed Cell Death 1 Receptor ; T-Lymphocytes ; Thyroid Gland ; Thyroiditis

Herein, we report a case of a 19-year-old man with multiple endocrine neoplasia type 2B (MEN2B) and medullary thyroid carcinoma (MTC) diagnosed when he was 12 years of age. The patient had previously undergone total thyroidectomy, cervical radiotherapy, and chemotherapy. He progressed with known bone, pulmonary, and lymph node metastases and was scanned with ¹⁸F-fluoride (¹⁸F-NaF) and ⁶⁸Ga-dotatate whole-body positron emission tomography/computed tomography (PET/CT) for metastatic disease monitoring.We found that the MTC bone metastases and soft tissue calcified metastases were better characterized on ¹⁸F-NaF PET/CT than on ⁶⁸Ga-dotatate PET/CT. This case illustrates that the ¹⁸F-NaF PET/CT could be helpful not only to the detection of bone metastases but also to the detection of calcified soft tissue metastases in patients with MTC.
Drug Therapy ; Electrons ; Humans ; Lymph Nodes ; Multiple Endocrine Neoplasia Type 2b ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Young Adult

PURPOSE: Thyroid cancer is a rare disease in pediatric population, but its incidence rate is increasing. The aim of this report is to present a single institution experience of pediatric thyroid cancer and to identify clinical features, predisposing factors, and postoperative course of pediatric thyroid cancer. METHODS: We retrospectively reviewed 35 pediatric patients who underwent operation due to thyroid cancer at Seoul National University Children's Hospital between May 1997 and January 2017. The median follow-up period was 70 months (range, 5–238 months). RESULTS: The mean age at operation was 12.0±5.91 years and 27 patients were female. The underlying conditions in patients included history of chemoradiotherapy for previous other malignancies (n=4), hypothyroidism (n=3), history of chemotherapy (n=2), family history of thyroid cancer (n=1) and history of radiation therapy (n=1). The initial symptoms were palpable neck mass (n=21) and incidental findings (n=11). Total thyroidectomy (n=30) or unilateral lobectomy (n=5) were performed. There were 15 postoperative complications including transient hypocalcemia in 14 patients and Horner's syndrome in 1 patient. The most common pathologic cell type was papillary thyroid cancer (n=29). Extrathyroid extension and lymph node invasion were found in 25 patients and 27 patients, respectively. Thirteen patients showed multifocality. During follow-up period, 5 patients underwent additional operation because of tumor recurrence in lymph nodes. Lung metastasis was detected in 3 patients at the time of diagnosis and in 3 patients during follow-up period. The mortality rate was zero and mean disease-free survival was 83.7±47.9 months. CONCLUSION: Pediatric thyroid cancer has lower mortality rate and recurrence rate as seen in this study despite the advanced stage at diagnosis. A thorough follow-up of patients with an underlying condition such as history of chemoradiotherapy and understanding new pediatric guideline can be helpful to maximize patients' survival and prognosis.
Causality ; Chemoradiotherapy ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Horner Syndrome ; Humans ; Hypocalcemia ; Hypothyroidism ; Incidence ; Incidental Findings ; Lung ; Lymph Nodes ; Mortality ; Neck ; Neoplasm Metastasis ; Pediatrics ; Postoperative Complications ; Prognosis ; Rare Diseases ; Recurrence ; Retrospective Studies ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

OBJECTIVES: In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. METHODS: The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. RESULTS: Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). CONCLUSIONS: A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.
Anxiety* ; Breast Neoplasms* ; Breast* ; Depression ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Radiotherapy ; Sleep Initiation and Maintenance Disorders* ; Thermometers ; Thyroid Gland* ; Thyroid Neoplasms*

Acromegaly is a rare disorder caused by excessive amounts of growth hormone. The incidence of colorectal, breast, and thyroid carcinomas is increased in acromegaly. However, there have been few reports on hematological malignancies in acromegaly. We describe a patient who developed acute lymphoblastic leukemia during the course of acromegaly. A 35-year-old woman presented in February 2012 with unexplained lactation and amenorrhea for 4 months. Her growth hormone level was 12.6 microg/L, insulin-like growth factor 1 592.26 ng/mL, and prolactin 242 microg/L. A pituitary macroadenoma secreting GH and prolactin causing acromegaly was diagnosed. Considering her fertility, the dopamine agonist cabergoline 0.5 mg was administered in March 2012. In February 2014, she presented with cytopenia (hemoglobin 12.2 g/dL, white cell count 2.69 x 10(9)/L, platelets 39 x 10(9)/L) and hepatosplenomegaly. A bone marrow examination showed acute B cell lymphoblastic leukemia. She underwent chemotherapy and bone marrow transplantation. A follow-up bone marrow biopsy showed remission.
Acromegaly* ; Adult ; Amenorrhea ; Biopsy ; Bone Marrow ; Bone Marrow Examination ; Bone Marrow Transplantation ; Breast ; Cell Count ; Dopamine Agonists ; Drug Therapy ; Female ; Fertility ; Follow-Up Studies ; Growth Hormone ; Hematologic Neoplasms ; Humans ; Incidence ; Insulin-Like Growth Factor I ; Lactation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prolactin ; Thyroid Neoplasms

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.
Abdomen/diagnostic imaging ; Chemical and Drug Induced Liver Injury/*diagnosis/drug therapy ; Female ; Humans ; Iodine Radioisotopes/chemistry ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Middle Aged ; Prednisolone/therapeutic use ; Thyroid Neoplasms/drug therapy/surgery ; Thyroidectomy ; Thyroxine/therapeutic use ; Ultrasonography

We report a rare case of co-occurrence of papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) and primary thyroid lymphoma. A 55-year-old woman presented with a large mass in left lobe of thyroid, biopsy confirmed diffuse large B-cell lymphoma. After 4 cycles of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisolone chemotherapy, positron emission tomography scan revealed markedly decreased in size, but still present. Repeated ultrasonography-guided gun biopsies of 2 lesions indicated Hurthle cell neoplasm. After total thyroidectomy and bilateral central lymph node dissection, residual hypermetabolic lesion of left lobe was determined to be FTC and right lower lesion to be nodular hyperplasia. Besides, a PTC was incidentally detected in left lobe. If there are multiple nodular lesions at diagnosis or there is insufficient response after 1st line chemotherapy for primary thyroid lymphoma, each lesion should be biopsied to confirm its pathological type.
Adenocarcinoma, Follicular ; Biopsy ; Carcinoma, Papillary* ; Cyclophosphamide ; Diagnosis ; Doxorubicin ; Drug Therapy ; Female ; Humans ; Hyperplasia ; Lymph Node Excision ; Lymphoma* ; Lymphoma, B-Cell ; Middle Aged ; Positron-Emission Tomography ; Prednisolone ; Rituximab ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Vincristine