SPLENOMEGALY AS THE FIRST MANIFESTATION OF THYROID-CANCER METASTASES

We report the case of a 65-year-old man who developed a symptomatic sp lenomegaly due to spleen metastasis from thyroid follicular carcinoma. In 1982, at the age of 53, the patient had undergone a thyroid lobect omy for a cold node, followed one year later by a second intervention for a microfollicular adenoma. He was subsequently administered thyroi d suppressive therapy with no further follow-up. The diagnosis of sple en metastases from thyroid cancer was first suspected on the basis of history, high serum thyroglobulin (Tg) levels, and the presence of pul monary Tc-99 uptake. The patient underwent a splenectomy, during which vast infiltration involving the diaphragm, spleen, stomach, colon and pancreas, was found. Histological and immunohistochemical results sho wed that the spleen and diaphragm metastases derived from thyroid foll icular carcinoma. Radioiodine uptake by the pulmonary metastases confi rmed the thyroid source. Retrospective re-evaluation of the thyroid ti ssue removed in 1983 revealed a histological pattern consistent with f ollicular carcinoma, which could not be unequivocally attributed to th e widely or minimally invasive form. To our knowledge this is the firs t report of splenomegaly as the first manifestation of thyroid cancer metastases. In this paper cases of splenomegaly due to metastatic spre ad are reviewed and the management of the present case is discussed.