Renal Metastases From Thyroid Cancer Masquerading as Renal Angiomyolipoma on Ultrasonography
Renal Metastases From Thyroid Cancer Masquerading as Renal Angiomyolipoma on Ultrasonography
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DOI：
10.7863/jum.2006.25.11.1459
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发表时间：
2006-11
影响因子：
2.3
通讯作者：
Mohammed Ahmed;Muhammad Aslam;J. Ahmed;H. Faraz;A. Almahfouz;Abdullah Al Arifi;H. Raef;F. Dayel
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文献类型：
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作者：
Mohammed Ahmed;Muhammad Aslam;J. Ahmed;H. Faraz;A. Almahfouz;Abdullah Al Arifi;H. Raef;F. Dayel
超声检查对肾脏病变的诊断价值是公认的。在此，我们报告了超声检查与其他成像方式（碘全身扫描[WBS]、计算机断层扫描[CT]和正电子发射断层扫描[PET]）在甲状腺乳头状癌（PTC）转移至肾脏的病例中的相对价值。超声能够显示肾脏病变，而WBS和PET未能显示肾脏病变。螺旋CT是超声检查的补充，但描绘了超声检查未发现的额外肾脏病变。肾脏超声检查的一个缺陷是将其解释为“血管平滑肌脂肪瘤的典型表现”。然而，正确的诊断是在CT扫描、细针穿刺活检（FNA Bx）和肾病变摘除并经组织学证实后建立的。我们的结论是，即使WBS和PET失败，超声检查在PTC转移性肾脏病变的检测中也是有价值的。然而，与任何其他成像方式一样，超声检查有其局限性。超声检查结果必须与CT扫描以及细胞学/组织学检查结果相辅相成，才能准确诊断PTC肾转移。原发性PTC的肾脏转移极为罕见。从1975年12月到2005年9月，在我们医院就诊的3500例甲状腺癌（TC）患者中，我们只有一例TC转移到肾脏的病例。我们建立了肾转移的诊断，以揭示放射性碘123 WBS阴性结果的有趣原因，但甲状腺球蛋白（TG）持续异常，这是一种重要的TC肿瘤标志物，在一位既往治疗的TC患者中随访了26年。本病例提供了一种算法，以达到诊断和适当的治疗这种不寻常的部位转移的TC。本病例明确了超声诊断TC肾转移的优点和局限性。2006年6月7日收到，来自医学系(m.a。沙特阿拉伯利雅得费萨尔国王专科医院和研究中心，H.A.F、A.A、A.A.A、H.R)、泌尿科（M.As）、放射科（J.A.）、病理学和检验医学（F.A.D.）；美国密歇根州底特律市韦恩州立大学医学部和底特律医疗中心（H.A.F.）。稿件于2006年6月19日接受发表。我们感谢Precy Manahan-Vidonia在秘书方面的帮助。寄给沙特阿拉伯利雅得11211费萨尔国王专科医院和研究中心MBC46医学部FRCP医学博士Mohammed Ahmed。E-mail: f1667141@yahoo.com缩写CT，计算机断层扫描；FNA Bx，细针穿刺活检；傅,随访;PET，正电子发射断层扫描；PTC，甲状腺乳头状癌；肾血管平滑肌脂肪瘤；TC，甲状腺癌；TG、甲状腺球蛋白;TSH、甲状腺刺激激素;WBS，全身扫描
he value of ultrasonography in detection of renal lesions is well recognized. Here, we report the relative value of ultrasonography compared with other imaging modalities (iodine whole-body scan [WBS], computed tomography [CT], and positron emission tomography [PET]) in a case of papillary thyroid cancer (PTC) metastatic to the kidney. Ultrasonography was able to show a renal lesion, in contrast to the failure of WBS and PET, which missed the kidney lesions. Spiral CT was complementary to ultrasonography but delineated an extra renal lesion that was not detected on ultrasonography. A pitfall of renal ultrasonography was the interpretation of the findings as “classic for angiomyolipoma.” However, the correct diagnosis was established after CT scanning, fine-needle aspiration biopsy (FNA Bx), and enucleation of the renal lesions with histologic confirmation. We conclude that ultrasonography is valuable in detection of metastatic renal lesions from PTC even when WBS and PET fail. However, as with any other imaging modality, ultrasonography has its limitations. Ultrasonographic findings must be complemented with CT scans along with cytologic/histologic findings in arriving at an accurate diagnosis of renal metastases from PTC. Renal metastases from primary PTC is extremely rare. Among the 3500 patients with thyroid cancer (TC) seen at our institution from December 1975 to September 2005, we have had only this single documented case of TC metastatic to the kidney. We established the diagnosis of renal metastases in our pursuit to uncover the intriguing cause of negative findings on the radioactive iodine 123 WBS but persistently abnormal findings for thyroglobulin (TG), an important tumor marker for TC, in a previously treated patient with TC who was followed for 26 years. This case provides an algorithm for arriving at the diagnosis and for appropriate treatment of this unusual site of TC metastases. The case defines the merits and the limitations of ultrasonography in the diagnosis of renal metastases from TC. Received June 7, 2006, from the Departments of Medicine (M.Ah., H.A.F., A.A., A.A.A., H.R), Urology (M.As.), Radiology (J.A.), and Pathology and Laboratory Medicine (F.A.D.), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; and Department of Medicine, Wayne State University and Detroit Medical Center, Detroit, Michigan USA (H.A.F.). Manuscript accepted for publication June 19, 2006. We thank Precy Manahan-Vidonia for secretarial help. Address correspondence to Mohammed Ahmed, MD, FRCP, Department of Medicine, MBC46, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11211, Saudi Arabia. E-mail: f1667141@yahoo.com Abbreviations CT, computed tomography; FNA Bx, fine-needle aspiration biopsy; FU, follow-up; PET, positron emission tomography; PTC, papillary thyroid cancer; RAML, renal angiomyolipoma; TC, thyroid cancer; TG, thyroglobulin; TSH, thyrotropin; WBS, whole-body scan