P1826 - Crossing Boundaries: Papillary Thyroid Cancer’s Journey to the Pancreas

Yasmin Gerais, MD¹, Marwah Alchalabi, MD², Marwan Ahmed, MD², Dolly Ewili, MD², Sammy Hamad, DO¹, Omar Alsalman, MD¹, Hasan Sqour, MD², Abdelsalam Sayed, MS³, Laura Hamad, DO¹, Michelle O'Leary, MD⁴, Fares Hamad, DO¹, Bachar Hamad, MD^4
1Ascension Saint Joseph Medical Center, Joliet, IL; ²Ascension Saint Joseph Hospital, Chicago, IL; ³University of Medical Science and Technology, Khartoum, Khartoum, Sudan; ⁴Ascension Saint Joseph Hospital, Joliet, IL

Introduction: Papillary thyroid cancer[PTC] is the most common type of thyroid cancer.PTC usually presents as a painless thyroid nodule or noted incidentally on imaging. Distant metastasis beyond the neck is rare. The most common site of distal metastasis are the lungs. Rarer sites of metastasis are the bones, kidneys, adrenals, liver and brain. PTC metastasizing to the pancreas is extremely rare. We present a rare case of PTC with metastasis to the pancreas.

Case Description/Methods: A 60 years old female with a history of papillary thyroid carcinoma(tall cell variant) diagnosed a decade ago status post-thyroidectomy and radioactive iodine therapy who presented with abdominal pain and decreased oral intake for two days. Computed tomography of her abdomen showed a pancreatic lesion. She underwent an Endoscopic ultrasound(EUS) that showed a suspicious lesion in the tail of the pancreas with possible invasion of the splenic artery followed by ultrasound guided fine needle aspiration(FNA) and biopsy. The initial most likely presumed diagnosis was a primary pancreatic neoplasm. Surprisingly, the results of FN biopsy was consistent with papillary thyroid cancer. The patient underwent exploratory staging laparoscopy, robotic assisted distal pancreatectomy with splenectomy. Results of the surgical pathology confirmed the diagnosis of PTC.

Discussion: PTC rarely presents with distant metastasis.PTC mainly presents as a painless thyroid nodule. The mainstay of treatment of PTC is surgical resection and radioactive iodine therapy. The Recurrence rate for PTC following treatment is as low as 4.3% and 2.8% depending on the aggressiveness of the initial stage. The most common sites for recurrence are lymph nodes followed by Distant metastasis to the lungs and bone. To the current date, Only 19 cases of PTC with metastasis to the pancreas have been identified. Among these cases, pancreatic lesions were located in the tail of the pancreas in five instances. Only four cases exhibited tall cell variant histology.The diagnosis was established with EUS guided biopsy in our case. Based on the literature review, surgical resection was the mode of treatment in 11 out of the 19 cases reported.The surgical procedure was largely dependent on the location of the tumor. Surgical procedures performed included pancreaticoduodenectomy[PD], distal pancreatectomy[DP] or distal pancreatectomy with splenectomy[DPS]. In our case the patient underwent DPS as the tumor was located in the tail of pancreas with extension to the splenic artery.



Disclosures:


Yasmin Gerais, MD¹, Marwah Alchalabi, MD², Marwan Ahmed, MD², Dolly Ewili, MD², Sammy Hamad, DO¹, Omar Alsalman, MD¹, Hasan Sqour, MD², Abdelsalam Sayed, MS³, Laura Hamad, DO¹, Michelle O'Leary, MD⁴, Fares Hamad, DO¹, Bachar Hamad, MD⁴. P1826 - Crossing Boundaries: Papillary Thyroid Cancer’s Journey to the Pancreas, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.