Endobronchial metastasis from an occult papillary thyroid carcinoma: a case report

It is well known that occult papillary thyroid cancers can result in regional lymph node metastasis. However, this small, clinically undetectable cancer rarely causes distant metastasis; moreover, an endobronchial presentation has not been described previously. We report on a 48-year-old man who experienced hemoptysis. A fiberoptic bronchoscopic biopsy established the diagnosis of endobronchial metastasis in the absence of clinically apparent thyroid cancer. After the patient was treated with a total thyroidectomy and radioactive iodine (131I), a whole body radioiodine scan revealed no evidence of distant functioning metastasis. A histological evaluation of the thyroid gland showed the presence of a 0.2 x 0.2 x 0.2 cm nodule in the right lobe. A left pneumonectomy was undertaken to treat the distant metastasis of the disease. Since most papillary thyroid carcinomas are curable, an aggressive surgical approach to the solitary metastasis is indicated.