PMC7661144_01
Computed tomography of lung tumors and a left adrenal tumor (arrows). (a) At the time when the left adrenal tumor was initially identified. (b) Six months after the initial diagnosis of the left adrenal tumor.
CRIONM2020-2107430.001.jpg
PMC7661144_01_CRIONM2020-2107430.001.jpg
fig1
We initially considered that the adrenal tumor might not have been a PTC metastasis (Figure 1), but the serum thyroglobulin level rapidly increased as high as 273.83 ng/mL in step with the growth of the tumor (although it had previously remained within the normal range (5.0-30.0 ng/mL) since the first diagnosis).
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedure and histopathological findings. (a) EUS-FNA was performed on the left adrenal tumor from the posterior wall of the stomach. (b) Histopathological findings showing a papillary structure similar to that of the resected thyroid cancer.
CRIONM2020-2107430.002.jpg
PMC7661144_01_CRIONM2020-2107430.002.jpg
fig2
Based on these findings, it was concluded that the left adrenal tumor was indeed a PTC metastasis (Figure 2).
Clinical course of the patient. (a) Serum thyroglobulin level (T) rapidly increased in step with the size of the left adrenal tumor. We initiated 24 mg lenvatinib treatment, but due to uncontrollable intratumoral bleeding, the patient had to undergo surgery. The serum thyroglobulin level immediately decreased after surgery, and the patient was again treated with lenvatinib, now at only 8 mg. (b) Computed tomography findings of intratumoral bleeding of the left adrenal tumor (arrow).
CRIONM2020-2107430.003.jpg
PMC7661144_01_CRIONM2020-2107430.003.jpg
fig3
We started 24 mg lenvatinib treatment for advanced RR-PTC five days after the EUS-FNA procedure, but 12 h later, the patient experienced sudden back pain due to intratumoral rebleeding (Figure 3).