PMC10179498_01
Ultrasound image and blood flow diagram of the patient's lesion. (A) Ultrasound showed that there was an isoechoic nodule in the right lobe of the patient, with a size of approximately 2*2 cm, a regular shape, and an uneven halo around the edge. (B) Blood flow map showed poor blood flow in the patient's right nodule. (C) Ultrasound showed that there was an isoechoic nodule in the right lobe of the patient, approximately 1.5*1 cm in size, with a regular shape and an uneven halo around the edge. (D) The blood flow map showed that the patient's left nodule did not have rich blood flow.
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Color Doppler ultrasound ( Figure 1 ) and computed tomography (CT) showed multiple nodules with increased signals in the bilateral lobes of the patient's thyroid; among them, the largest nodule on the right side was 2.0*2.0 cm and the largest nodule on the left side was 1.0*1.5 cm.
The patient's preoperative colonoscopy images and pathological images of rectal tumors. (A) The patient's preoperative colonoscopy images. (B) The patient's preoperative pathological images of rectal tumors.
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The result of enteroscopy suggested a rectal mass ( Figure 2A ) and the patient had previously undergone radical rectal resection for a rectal neuroendocrine neoplasm (NEN). The postoperative pathology showed a neuroendocrine tumor ( Figure 2B ), with a tumor size of 3.1cm*2.5cm, and the immunohistochemical results showed CK7[-], CK20[focal +], CKpan[+], Syn[+], CgA[-], CDX2[-], CD56[+], Ki67[5-10%], and EMA[partially+].
Histological findings of a rectal neuroendocrine tumor metastasized to the thyroid. (A) Rectal neuroendocrine tumors are indicated by white arrows, and normal thyroid epithelial cells are indicated by black arrows (HE; 100X). (B) Metastatic neuroendocrine tumor without normal thyroid tissue (HE; 400X).
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Postoperative pathology suggested bilateral metastatic thyroid NENs ( Figure 3 ) and the immunohistochemical results showed CK[+], TG[-], TTF1 slightly scattered[+], HBME-1[-], S-100[-], Calcitonin[-], CgA[+], Syn[+], Ki-67[+] 10-20%, CK19 [+], CK20[-], PAX 8[-], CEA[-], CDX2[-] and SATB2[-] ( Figure 4 ).
Immunohistochemical and cytological evidence of rectal neuroendocrine tumor metastasis to the thyroid. (A) Cancer cells negative for S-100 (S-100; 400X). (B) HE staining demonstrated typical neuroendocrine tumor morphology (HE; 400X). (C) Cancer cells positive for CgA (CgA; 400X). (D) Cancer cells positive for Syn (Syn; 400X).
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Postoperative pathology suggested bilateral metastatic thyroid NENs ( Figure 3 ) and the immunohistochemical results showed CK[+], TG[-], TTF1 slightly scattered[+], HBME-1[-], S-100[-], Calcitonin[-], CgA[+], Syn[+], Ki-67[+] 10-20%, CK19 [+], CK20[-], PAX 8[-], CEA[-], CDX2[-] and SATB2[-] ( Figure 4 ).