Is pancreatic resection justified for metastasis of papillary thyroid cancer?

This case report describes a patient with symptomatic anaemia due to a bleeding duodenal metastasis from metastasising differentiated thyroid cancer (DTC), which was treated by partial duodenopancreatectomy (DP).

A 71-year old male was sent to hospital with severe anaemia. This patient had suffered multiple cervical recurrences of differentiated papillary thyroid cancer, which had been treated by several resections and irradiation, and an adrenal gland metastasis, via adrenalectomy. Abdominal computed tomography showed an enlarged pancreatic head, an upper gastrointestinal endoscopy revealed a bleeding ulcer in the duodenum, and a biopsy revealed metastasis from DTC. Due to the symptomatic metastasis, a partial DP was performed; the postoperative course was uneventful. Histopathological examination revealed metastasis of the DTC next to the papilla lying in the head of the pancreas, with growth into the muscularis propria of the duodenum. The patient survived for another 41/2 years before dying from progressive metastatic disease elsewhere.

DP for metastatic disease should be considered in selected patients for alleviation of the symptoms and prolongation of survival, as long as this operation is performed by experienced surgeons who can achieve minimal morbidity and mortality.