PLEURAL EFFUSION IN PATIENTS WITH DIFFERENTIATED PAPILLARY THYROID-CANCER

Among 1,772 patients who registered at the MD Anderson Cancer Center b etween 1944 and 1991 with papillary thyroid cancer, 10 had malignant p leural effusion that developed during the course of the disease. At pr imary surgery, all IO were found to have metastases to cervical lymph nodes. Seven of these patients also had invasion into adjacent soft ti ssues, 4 had lung metastases, and 1 had pleural effusion. All patients had radiologically apparent lung metastases at the time pleural effus ion was found. Malignant effusion appeared 0 to 60 months after abnorm al chest radiographs in 9 patients and 61 to 132 months after the init ial diagnosis of thyroid cancer in 4 patients. Pleural effusions were treated with local radioisotopes or sclerosing agents, systemic radioi odine or chemotherapy, or both. All 10 patients died of thyroid cancer ; overall survival time was 7 to 170 months (median, 27 months); howev er, appearance of pleural effusion preceded death by 1 to 20 months (m edian, 11 months). Malignant pleural effusion complicates the clinical course in 0.6% of adult patients with papillary thyroid cancer. It ma y develop many years after the initial diagnosis but is associated wit h greatly shortened survival time in all cases.