Pleural fluid due to papillary thyroid cancer

Area of Science:

• Oncology
• Pulmonology
• Pathology

Background:

• Papillary thyroid cancer is a common endocrine malignancy.
• Metastatic spread of thyroid cancer can occur, but pleural effusion is a rare manifestation.
• Long-term survivors of thyroid cancer may still develop rare complications.

Purpose of the Study:

• To report a rare case of massive pleural effusion secondary to metastatic papillary thyroid cancer.
• To highlight the diagnostic utility of cytological and immunocytochemical analysis in pleural fluid.
• To discuss the implications for long-term management of papillary thyroid cancer survivors.

Main Methods:

• Case presentation of a 91-year-old male with shortness of breath.
• Diagnostic thoracentesis for pleural fluid collection and cytological examination.
• Immunocytochemical staining of pleural fluid cells for cytokeratin (CK)-7, CK-19, and thyroglobulin.

Main Results:

• Massive right-sided pleural effusion was identified as the primary presenting symptom.
• Cytological analysis of pleural fluid confirmed metastatic papillary thyroid carcinoma.
• Immunocytochemistry was positive for CK-7, CK-19, and thyroglobulin, consistent with thyroid origin.
• The patient had a history of surgically resected thyroid cancer 6 years prior.

Conclusions:

• Massive pleural effusion can be a rare but significant complication of metastatic papillary thyroid cancer.
• This case underscores the importance of considering metastatic disease in long-term survivors presenting with unexplained pleural effusions.
• Diagnostic tools like immunocytochemistry are crucial for identifying the origin of malignant cells in pleural fluid.