Resection of liver metastases from differentiated thyroid cancer: who might benefit? Report of 2 cases and review of literature

Abstract

Background: Liver metastases of differentiated thyroid cancers (DTC) are uncommon. Surgery has proved its effectiveness in patients with 131I negative hepatic lesions. Here we present two patients who underwent liver resection for metastases of DTC. Case presentation: The first patient is a 36-year-old woman who presented with 70 mm large hepatic metastases of papillary thyroid cancer. After treatment of the primary cancer she was disease free for eight years when the elevation of TSH level resulted in the search for metastasis. Notably, the 131I SPECT did not show any lesions. The CT scan visualized 80mm diameter mass within the liver. Histology confirmed metastasis of the thyroid cancer. Lack of iodine uptake and size of the lesion excluded treatment with radioactive iodine. Radical resection of the metastasis was performed with good short and long-term postoperative result. The second patient is the 65-year-old man who was previously treated for follicular thyroid cancer. When iodine negative 70mm diameter metastasis was detected within the liver he was referred for surgery. The right extended hemihepatectomy was performed. In 12-months follow-up he remained stable, with no signs of disease recurrence. Conclusions: These two cases show that resection of hepatic metastases of DTC is an option even if the lesions are large. Given the effectiveness and safety of liver surgery we reckon that it should be the treatment of choice when is possible. Decision of surgical treatment should be based on analysis of the ability to perform the radical and safe resection.