Didactic surgical experience of thyroid metastasis from renal cell carcinoma: A case report
Didactic surgical experience of thyroid metastasis from renal cell carcinoma: A case report
复制标题
DOI：
10.12998/wjcc.v6.i15.1018
复制
发表时间：
2018-12-06
影响因子：
1.1
通讯作者：
Kuratomi, Yuichiro
中科院分区：
文献类型：
--
作者：
Yamauchi, Moriyasu;Kai, Keita;Kuratomi, Yuichiro
背景：治疗肾细胞癌甲状腺转移的最佳治疗策略尚未明确。我们在此报告一例引起术中大量出血的疾病的教学手术经验。病例摘要：一名59岁男性患者，在左肾肾细胞癌手术治疗前，胸部计算机断层扫描发现甲状腺左叶软肿块。甲状腺肿块最初被认为是良性的，然后他接受了左肾根治术。肾切除术一年后，行立体定向放射手术治疗脑转移。随访中，甲状腺结节逐渐增大，患者出现吞咽不适。经临床诊断为甲状腺滤泡性肿瘤，行左半甲状腺切除术。虽然甲状腺切除术通常是一种安全而直接的手术，但明显发育的肿瘤血管的大量出血使手术非常困难。甲状腺肿瘤最终被诊断为透明细胞癌转移。结论当发现肾细胞癌患者或既往有肾细胞癌病史的患者有甲状腺病变时，临床医生应考虑甲状腺转移的可能性，以选择合适的手术时机。我们建议甲状腺转移的肾细胞癌应尽早切除，即使患者有其他转移部位。
BACKGROUNDThe optimal therapeutic strategy in treating thyroid metastasis from renal cell carcinoma (RCC) has not been clearly established. Here we describe a case of didactic surgical experience of the disease which caused massive intraoperative bleeding.CASE SUMMARYA 59-year-old male patient presented with a thyroid left lobe soft mass detected by chest computed tomography scans prior to the surgical treatment of RCC of the left kidney. The thyroid mass was initially considered to be benign, then he underwent left radical nephrectomy. One year after the nephrectomy, stereotactic radio-surgery was performed for brain metastasis. During follow-up, the thyroid nodule gradually grew, and the patient manifested swallowing discomfort. Under a clinical diagnosis of thyroid follicular neoplasm, left hemithyroidectomy was performed. Although hemithyroidectomy is usually a safe and straightforward procedure, massive bleeding from markedly developed tumor vessels made the operation very difficult. The thyroid tumor was finally diagnosed as metastasis from clear cell RCC.CONCLUSIONFor proper timing of the surgery, a clinician should take into consideration the possibility of thyroid metastasis of RCC when a thyroid lesion is found in patients with RCC or in patients with a previous history of RCC. We recommend that thyroid metastasis of RCC should be resected as early as possible even if a patient has other metastatic sites.