Association between Serum Thyroid Stimulating Hormone Level and Papillary Thyroid Microcarcinoma in Korean Euthyroid Patients

BACKGROUND: Thyroid cancer is a common disease and its prevalence is increasing. Recent reports have shown that an elevated thyrotropin (thyroid stimulating hormone, TSH) level is associated with thyroid cancer risk. However, the association between TSH level and thyroid cancer risk is not yet known for euthyroid patients diagnosed with papillary thyroid microcarcinoma (PTMC). METHODS: Our study included 425 patients who underwent thyroid surgery and were diagnosed with PTMC between 2008 and 2009. Control group patients were diagnosed with benign nodules < or = 1 cm in size by US-guided fine needle aspiration. Nodules with one or more suspected malignant-ultrasonographic feature(s) were excluded from this study. Patients who were not euthyroid or who took thyroid medication were also excluded. RESULTS: The mean age of all patients was 48.5 +/- 11.0 years and 88.8% were women. The mean age of those with PTMC was significantly lower than that of the control group. The mean TSH level was 1.78 +/- 0.93 mIU/L, and the mean free T4 level was 15.96 +/- 2.32 pmol/L. There was no difference in TSH level between the PTMC and control groups (1.77 +/- 0.93 mIU/L vs. 1.79 +/- 0.91 mIU/L, P = 0.829). After adjusting for age, TSH level was not correlated with tumor size (r = 0.02, P = 0.678) in the PTMC group. Moreover, the TSH level did not differ between patients with stage I and stage III-IV carcinoma (stage I, 1.77 +/- 0.95 mIU/L; stage III-IV, 1.79 +/- 0.87 mIU/L; P = 0.856). CONCLUSION: TSH levels are not elevated in euthyroid PTMC patients. Thus, further evaluation is needed before serum TSH can be used as a tumor marker for small nodules < or = 1 cm in size in euthyroid patients.

A Case of Squamous Cell Lung Cancer with Metastasis of the Stomach / 대한소화기내시경학회지

Blood-borne metastatic involvement of the gastric mucosa as a result of cancer is a rare occurrence. The tumors which were most commonly reported to metastasize to the stomach include melanoma, breast carcinoma, and lung carcinoma. Some reports document that large cell carcinoma and squamous cell carcinoma of the lungs have a higher pre- dilection for gastrointestinal tract metastases. Upper gastrointestinal endoscopic findings of metastatic lesions may vary but often produce a characteristic single or multiple bulls eye or target lesion. Therefore, whenever single or multiple target lesions are seen in the stomach on upper gastrointestinal endoscopy or barium study, the examination should include careful radiographic evaluation of the chest. Moreover, when the patient is known to have lung cancer, metastatic disease should be suspected. With a correct diagnosis and proper treatment, relief of symptoms and prolongation of life can sometimes be achieved, A case in reported involving squamous cell lung cancer with stomach metastasis in a 73 year-old woman. The patient was diagnosed by bronchoscopy, upper gastrointestinal endoscopy, chest CT, and abdominal CT. The chest and abdominal CT revealed a poorly marginated, lobulated, and 4 x 3 cm sized mass lesion in the right lower lobe causing obstruction of right lower lobe bronchus with invasion to the left atrium. right inferior pulmonary vein, and superior vena cava. Mediastimal lymph node enlargement and liver metastasis was also detected. Upper gastrointestinal endoscopy showed two "bulls eye" lesions with different sizes and two nodules without tip ulceration.