Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report
Abstract Background The major sites of distant metastases of papillary thyroid carcinoma (PTC) are the lung and bone; metastasis to the liver is rare. Although the postoperative serum thyroglobulin (Tg) level after total thyroidectomy is a good prognostic indicator for PTC when anti-thyroglobulin an...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-03-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01397-7 |
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| author | Minoru Kihara Akira Miyauchi Mitsuyoshi Hirokawa Makoto Fujishima Hiroo Masuoka Takuya Higashiyama Naoyoshi Onoda Yasuhiro Ito Akihiro Miya |
| author_facet | Minoru Kihara Akira Miyauchi Mitsuyoshi Hirokawa Makoto Fujishima Hiroo Masuoka Takuya Higashiyama Naoyoshi Onoda Yasuhiro Ito Akihiro Miya |
| author_sort | Minoru Kihara |
| collection | DOAJ |
| description | Abstract Background The major sites of distant metastases of papillary thyroid carcinoma (PTC) are the lung and bone; metastasis to the liver is rare. Although the postoperative serum thyroglobulin (Tg) level after total thyroidectomy is a good prognostic indicator for PTC when anti-thyroglobulin antibody (TgAb) is negative, the presence of TgAb interferes with the Tg assay, making serum Tg levels unreliable. Here we report a case of liver metastasis of PTC that presented with elevated serum levels of carbohydrate antigen 19-9 (CA19-9), which is usually a serum marker of pancreatic and gastrointestinal neoplasias. Case presentation A 69-year-old man was diagnosed with PTC and underwent total thyroidectomy 16 years ago. The patient’s serum Tg levels increased progressively during follow-up and his serum TgAb was negative. Positron emission tomography (PET) and computed tomography (CT) revealed metastases of the lung, cervical spine, mediastinum and liver. The liver lesion was a solitary tumor measuring 4.0 cm in the greatest dimension. His serum CA19-9 level was very high (326 U/mL), and intrahepatic cholangiocarcinoma was suspected from the results of various examinations including gastrointestinal endoscopic imaging and CT. Laparoscopic partial liver resection for segment 4 was performed. The histopathological diagnosis was a metastatic liver tumor from PTC. The immunohistological examination revealed that the liver tumor was positive for CA19-9 and Tg. The primary PTC, recovered from paraffin-embedded specimen, was also positive for CA19-9. After the surgery, his serum CA19-9 level as well as serum Tg level markedly decreased. Conclusions We presented the first reported case of liver metastasis of a PTC presenting with elevated serum levels of CA19-9 after total thyroidectomy. This case suggests that the serum CA19-9 levels may serve as a surrogate marker for PTC in place of the serum Tg level in patients with positive serum TgAb if the PTC and/or the metastatic lesions are positive for CA19-9 staining. |
| first_indexed | 2024-12-13T19:10:20Z |
| format | Article |
| id | doaj.art-6cb3636af3974c4fb1096e6ed53e632a |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-13T19:10:20Z |
| publishDate | 2022-03-01 |
| publisher | SpringerOpen |
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| series | Surgical Case Reports |
| spelling | doaj.art-6cb3636af3974c4fb1096e6ed53e632a2022-12-21T23:34:26ZengSpringerOpenSurgical Case Reports2198-77932022-03-01811510.1186/s40792-022-01397-7Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case reportMinoru Kihara0Akira Miyauchi1Mitsuyoshi Hirokawa2Makoto Fujishima3Hiroo Masuoka4Takuya Higashiyama5Naoyoshi Onoda6Yasuhiro Ito7Akihiro Miya8Departments of Surgery, Kuma HospitalDepartments of Surgery, Kuma HospitalDepartment of Diagnostic Pathology, Kuma HospitalDepartments of Surgery, Kuma HospitalDepartments of Surgery, Kuma HospitalDepartments of Surgery, Kuma HospitalDepartments of Surgery, Kuma HospitalDepartments of Surgery, Kuma HospitalDepartments of Surgery, Kuma HospitalAbstract Background The major sites of distant metastases of papillary thyroid carcinoma (PTC) are the lung and bone; metastasis to the liver is rare. Although the postoperative serum thyroglobulin (Tg) level after total thyroidectomy is a good prognostic indicator for PTC when anti-thyroglobulin antibody (TgAb) is negative, the presence of TgAb interferes with the Tg assay, making serum Tg levels unreliable. Here we report a case of liver metastasis of PTC that presented with elevated serum levels of carbohydrate antigen 19-9 (CA19-9), which is usually a serum marker of pancreatic and gastrointestinal neoplasias. Case presentation A 69-year-old man was diagnosed with PTC and underwent total thyroidectomy 16 years ago. The patient’s serum Tg levels increased progressively during follow-up and his serum TgAb was negative. Positron emission tomography (PET) and computed tomography (CT) revealed metastases of the lung, cervical spine, mediastinum and liver. The liver lesion was a solitary tumor measuring 4.0 cm in the greatest dimension. His serum CA19-9 level was very high (326 U/mL), and intrahepatic cholangiocarcinoma was suspected from the results of various examinations including gastrointestinal endoscopic imaging and CT. Laparoscopic partial liver resection for segment 4 was performed. The histopathological diagnosis was a metastatic liver tumor from PTC. The immunohistological examination revealed that the liver tumor was positive for CA19-9 and Tg. The primary PTC, recovered from paraffin-embedded specimen, was also positive for CA19-9. After the surgery, his serum CA19-9 level as well as serum Tg level markedly decreased. Conclusions We presented the first reported case of liver metastasis of a PTC presenting with elevated serum levels of CA19-9 after total thyroidectomy. This case suggests that the serum CA19-9 levels may serve as a surrogate marker for PTC in place of the serum Tg level in patients with positive serum TgAb if the PTC and/or the metastatic lesions are positive for CA19-9 staining.https://doi.org/10.1186/s40792-022-01397-7Papillary thyroid carcinomaCarbohydrate antigen 19-9 (CA19-9)Liver metastasisThyroglobulinAnti-thyroglobulin antibody |
| spellingShingle | Minoru Kihara Akira Miyauchi Mitsuyoshi Hirokawa Makoto Fujishima Hiroo Masuoka Takuya Higashiyama Naoyoshi Onoda Yasuhiro Ito Akihiro Miya Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report Surgical Case Reports Papillary thyroid carcinoma Carbohydrate antigen 19-9 (CA19-9) Liver metastasis Thyroglobulin Anti-thyroglobulin antibody |
| title | Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report |
| title_full | Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report |
| title_fullStr | Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report |
| title_full_unstemmed | Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report |
| title_short | Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report |
| title_sort | metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19 9 ca19 9 a case report |
| topic | Papillary thyroid carcinoma Carbohydrate antigen 19-9 (CA19-9) Liver metastasis Thyroglobulin Anti-thyroglobulin antibody |
| url | https://doi.org/10.1186/s40792-022-01397-7 |
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