Autopsy and Case Reports
Autopsy and Case Reports
Autopsy Case Report

Small bowel perforation and death caused by anaplastic thyroid carcinoma metastasis in a patient with concomitant colonic and bilateral breast carcinoma.

Jan Hrudka; Ivana Švadlenková

Downloads: 3
Views: 1027


Undifferentiated or anaplastic thyroid carcinoma (ATC) is rare and one of the most aggressive human malignancies. The tumor is usually voluminous and fast-growing and mostly affects older women. The most common sites of distant metastases are the lungs, brain, and bones. Herein, we describe the case of a 66-year-old woman with a history of bilateral breast carcinoma and ATC, who presented with an acute abdomen and subsequently died. At autopsy, an isolated metastasis of ATC in the small intestine leading to bowel perforation was found. Moreover, there was adenocarcinoma in the descending colon. The review of extra-abdominal malignancies metastasizing to bowel and coincidence of breast and thyroid carcinoma is included.


Carcinoma, Intestinal Perforation, Neoplasm Metastasis, Thyroid Carcinoma, Anaplastic


1 El-Naggar AK, Baloch ZW, Eng C, et al. Anaplastic thyroid carcinoma. In: Lloyd RV, Osamura RY, Klöppel G, Rosai J, editors. WHO Classification of tumours of endocrine organs. 4th ed. Lyon: IARC; 2017. p. 104-6.

2 Yun JY, Kim YA, Choe JY, et al. Expression of cancer stem cell markers is more frequent in anaplastic thyroid carcinoma compared to papillary thyroid carcinoma and is related to adverse clinical outcome. J Clin Pathol. 2014;67(2):125-33. PMid:23986551.

3 Bishop JA, Sharma R, Westra WH. PAX8 immunostaining of anaplastic thyroid carcinoma: a reliable means of discerning thyroid origin for undifferentiated tumors of the head and neck. Hum Pathol. 2011;42(12):1873-7. PMid:21663937.

4 Lai WA, Hang JF, Liu CY, et al. PAX8 expression in anaplastic thyroid carcinoma is less than those reported in early studies: a multi-institutional study of 182 cases using the monoclonal antibody MRQ-50. Virchows Arch. 2020;476(3):431-7. PMid:31732814.

5 LiVolsi VA, Brooks JJ, Arendash-Durand B. Anaplastic thyroid tumors. Immunohistology. Am J Clin Pathol. 1987;87(4):434-42. PMid:2435145.

6 Hurlimann J, Gardiol D, Scazziga B. Immunohistology of anaplastic thyroid carcinoma. A study of 43 cases. Histopathology. 1987;11(6):567-80. PMid:2442086.

7 Latteyer S, Tiedje V, König K, et al. Targeted next-generation sequencing for TP53, RAS, BRAF, ALK and NF1 mutations in anaplastic thyroid cancer. Endocrine. 2016;54(3):733-41. PMid:27696251.

8 Bonhomme B, Godbert Y, Perot G, et al. Molecular pathology of anaplastic thyroid carcinomas: A Retrospective Study of 144 Cases. Thyroid. 2017;27(5):682-92. PMid:28351340.

9 Wenig BM. Atlas of head and neck pathology. 3rd ed. Philadelphia: Elsevier; 2016. Pp. 1381-1424.

10 Brandwein-Gensler MS, Wang BY, Urken ML. Spindle cell transformation of papillary carcinoma: an aggressive entity distinct from anaplastic thyroid carcinoma. Arch Pathol Lab Med. 2004;128(1):87-9. PMid:14692805.

11 Cabanillas ME, Zafereo M, Gunn GB, Ferrarotto R. Anaplastic thyroid carcinoma: treatment in the age of molecular targeted therapy. J Oncol Pract. 2016;12(6):511-8. PMid:27288464.

12 Brignardello E, Gallo M, Baldi I, et al. Anaplastic thyroid carcinoma: clinical outcome of 30 consecutive patients referred to a single institution in the past 5 years. Eur J Endocrinol. 2007;156(4):425-30. PMid:17389456.

13 Hvilsom GB, Londero SC, Hahn CH, et al. Anaplastic thyroid carcinoma in Denmark 1996–2012: A national prospective study of 219 patients. Cancer Epidemiol. 2018;53:65-71. PMid:29414634.

14 Kebebew E, Greenspan FS, Clark OH, Woeber KA, McMillan A. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer. 2005;103(7):1330-5. PMid:15739211.

15 Phillips DL, Benner KG, Keeffe EB, Traweek ST. Isolated metastasis to small bowel from anaplastic thyroid carcinoma. With a review of extra-abdominal malignancies that spread to the bowel. J Clin Gastroenterol. 1987;9(5):563-7. PMid:3680909.

16 Ricciardelli L, Rapicano G, Pinto A, et al. Small bowel intussusception caused by metastasis from anaplastic thyroid carcinoma: case report and literature review. Ann Ital Chir. 2006;77(1):63-7. PMid:16910363.

17 Gavriilidou S, Belis C, Afentoulidi A, et al. (2019, May 18). Jejunum metastasis and perforation from anaplastic thyroid cancer. In Proceedings of the 21st European Congress of Endocrinology (Vol. 63). Lyon, France.

18 Kobayashi M, Itabashi H, Ikeda T, Yamazaki N, Kaji T, Takagane A. Simultaneous occurrence of distant metastases to the small intestine and the thoracic esophagus from anaplastic thyroid carcinoma: A case report. Surg Case Rep. 2015;1(1):63. PMid:26366360.

19 Hosoda K, Kusama K, Yanagisawa N, et al. Anaplastic transformation of thyroid cancer in mesentery metastases presenting as intestinal perforation: a case report. Surg Case Rep. 2020;6(1):194. PMid:32748087.

20 Fujii Y, Homma S, Yoshida T, Taketomi A. Jejunal intussusception caused by metastasis of a giant cell carcinoma of the lung. BMJ Case Rep. 2016;2016:bcr2016216030. PMid:27485876.

21 Jarmin R, Azman A, Rahim R, Kosai NR, Das S. A rare case of intussusception associated with metastasized small cell carcinoma of lung. Acta Med Iran. 2012;50(11):782-4. PMid:23292632.

22 Mandeville Y, de Gheldere C, Vanclooster P. Small bowel intussusception caused by multiple intestinal metastases from a giant cell carcinoma of the lung: a case report. Acta Chir Belg. 2015;115(1):49-51.

23 Kagohashi K, Kadono K, Satoh H, Ohtsuka M. Intussusception due to intestinal metastasis from lung cancer. Lung Cancer. 2007;57(2):247-8. PMid:17602784.

24 Jung SP, Han KM, Bae JW, Kim JH. Recurrent intussusception caused by intestinal metastasis of pulmonary pleomorphic carcinoma. Kaohsiung J Med Sci. 2014;30(7):378-9. PMid:24924845.

25 Lin MW, Wu CT, Chang YL. Intussusception caused by intestinal metastasis from lung pleomorphic carcinoma. Ann Thorac Cardiovasc Surg. 2014;20(Suppl):635-8. PMid:23903709.

26 Wou C, Sharp E, Johnson L. Intussusception secondary to a solitary peritoneal lung metastasis. BMJ Case Rep. 2013;2013(apr22 1):bcr2012008370. PMid:23608839.

27 Pollheimer MJ, Eberl T, Baumgartner K, et al. Ileocecal intussusception caused by lung cancer metastasis. Wien Klin Wochenschr. 2009;121(11-12):413-6. PMid:19626300.

28 Guner A, Karyagar S, Livaoglu A, Kece C, Kucuktulu U. Small bowel intussusception due to metastasized sarcomatoid carcinoma of the lung: a rare cause of intestinal obstruction in adults. Case Rep Surg. 2012;2012:962683. PMid:23346451.

29 Lee JW, Kim SK, Park JW, Lee HS. Unexpected small bowel intussusception caused by lung cancer metastasis on 18F-fluorodeoxyglucose PET-CT. Ann Thorac Surg. 2010;90(6):2037-9. PMid:21095361.

30 Leidich RB, Rudolf LE. Small bowel perforation secondary to metastatic lung carcinoma. Ann Surg. 1981;193(1):67-9. PMid:7458451.

31 Garavello A, Fransvea P, Rossi S, Giacovazzo F, Marino V. Bowel perforation secondary to metastatic lung cancer: report of two cases with literature review. Int J Surg Case Rep. 2018;51:331-4. PMid:30245356.

32 Salemis NS, Nikou E, Liatsos C, Gakis C, Karagkiouzis G, Gourgiotis S. Small bowel perforation secondary to metastatic non-small cell lung cancer. A rare entity with a dismal prognosis. J Gastrointest Cancer. 2012;43(3):391-5. PMid:22033892.

33 Bélanger M, Gagné JP. Mock appendicitis: small bowel perforation secondary to lung cancer metastasis. Can J Surg. 2009;52(5):E205-6. PMid:19865561

34 Sakorafas GH, Pavlakis G, Grigoriadis KD. Small bowel perforation secondary to metastatic lung cancer: a case report and review of the literature. Mt Sinai J Med. 2003;70(2):130-2. PMid:12634905.

35 Garwood RA, Sawyer MD, Ledesma EJ, Foley E, Claridge JA. A case and review of bowel perforation secondary to metastatic lung cancer. Am Surg. 2005;71(2):110-6. PMid:16022008.

36 Capasso L, Iarrobino G, D’ Ambrosio R, Carfora E, Ventriglia R, Borsi E. Complicanze chirurgiche per metastasi gastriche e digiuno-ileali da carcinoma primitivo polmonare. Minerva Chir. 2004;59(4):397-403. PMid:15278035.

37 Huang TW, Wang CH, Tsai WC, Liu YC. Small bowel perforation secondary to metastatic lung cancer: a case report with literature review. Visc Med. 2006;22(2):92-4.

38 Yuksel O, Uyar P, Sahin TT, Demirhan B. Small bowel perforation due to metastatic lung squamous cell carcinoma. Saudi Med J. 2007;28(4):631-3. PMid:17457493.

39 Di JZ, Peng JY, Wang ZG. Prevalence, clinicopathological characteristics, treatment, and prognosis of intestinal metastasis of primary lung cancer: A comprehensive review. Surg Oncol. 2014;23(2):72-80. PMid:24656432.

40 Wang J, Chen Y, Zhang S, Chen Q. Perforation of small intestine secondary to metastatic lung adenocarcinoma: A case report. Medicine (Baltimore). 2018;97(49):e13469. PMid:30544434.

41 Brikman S, Chertok E, Dori G. Perforation of small intestine due to metastatic lung carcinoma. BMJ Case Rep. 2018;2018:bcr2018225708. PMid:30206057.

42 Sato S, Senmaru N, Ishido K, et al. Perforation of small intestinal metastasis of lung adenocarcinoma treated with pembrolizumab: a case report. Surg Case Rep. 2019;5(1):166. PMid:31667679.

43 Gatsoulis N, Roukounakis N, Kafetzis I, Gasteratos S, Mavrakis G. Small bowel intussusception due to metastatic malignant melanoma: A case report. Tech Coloproctol. 2004;8(S1, Suppl 1):s141-3. PMid:15655601.

44 Bender GN, Maglinte DD, McLarney JH, Rex D, Kelvin FM. Malignant melanoma: patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance. Am J Gastroenterol. 2001;96(8):2392-400. PMid:11513180.

45 Butte JM, Meneses M, Waugh E, Parada H, De La Fuente H. Ileal intussusception secondary to small bowel metastases from melanoma. Am J Surg. 2009;198(1):e1-2. PMid:19268910.

46 Huang YJ, Wu MH, Lin MT. Multiple small-bowel intussusceptions caused by metastatic malignant melanoma. Am J Surg. 2008;196(3):e1-2. PMid:18513686.

47 Capizzi PJ, Donohue JH. Metastatic melanoma of the gastrointestinal tract: a review of the literature. Compr Ther. 1994;20(1):20-3. PMid:8137614.

48 Strobel K. Small intestine invagination in metastatic intestinal malignant melanoma. RoFo Fortschr Geb Rontgenstr Nuklearmed. 2001;173(8):768-9. PMid:11570251.

49 Hegde RG, K H, Agrawal RD, Yadav VK, Khadse GJ. Renal cell carcinoma presenting as small bowel obstruction secondary to a metastatic ileal intussusception. J Radiol Case Rep. 2014;8(4):25-31. PMid:24967032.

50 Roviello F, Caruso S, Moscovita Falzarano S, et al. Small bowel metastases from renal cell carcinoma: a rare cause of intestinal intussusception. J Nephrol. 2006;19(2):234-8. PMid:16736429.

51 Hofflander R, Beckes D, Kapre S, Matolo N, Liu S. A case of jejunal intussusception with gastrointestinal bleeding caused by metastatic testicular germ cell cancer. Dig Surg. 1999;16(5):439-40. PMid:10567810.

52 Hung GY, Chiou T, Hsieh YL, Yang MH, Chen WY. Intestinal metastasis causing intussusception in a patient treated for osteosarcoma with history of multiple metastases: A case report. Jpn J Clin Oncol. 2001;31(4):165-7. PMid:11386464.

53 Horiuchi A, Watanabe Y, Yoshida M, Yamamoto Y, Kawachi K. Metastatic osteosarcoma in the jejunum with intussusception: report of a case. Surg Today. 2007;37(5):440-2. PMid:17468831.

54 Boehm R, Till H, Landes J, Schmid I, Joppich I. Ileoileal intussusception caused by a Ewing sarcoma tumour. An unusual case report. Eur J Pediatr Surg. 2003;13(4):272-5. PMid:13680499.

55 Wächter S, Vorländer C, Schabram J, et al. Anaplastic thyroid carcinoma: changing trends of treatment strategies and associated overall survival. Eur Arch Otorhinolaryngol. 2020;277(5):1507-14. PMid:32060602.

56 Rosove MH, Peddi PF, Glaspy JA. BRAF V600E inhibition in anaplastic thyroid cancer. N Engl J Med. 2013;368(7):684-5. PMid:23406047.

57 Nikiforova MN, Kimura ET, Gandhi M, et al. BRAF mutations in thyroid tumors are restricted to papillary carcinomas and anaplastic or poorly differentiated carcinomas arising from papillary carcinomas. J Clin Endocrinol Metab. 2003;88(11):5399-404. PMid:14602780.

58 Takano T, Ito Y, Hirokawa M, Yoshida H, Miyauchi A. BRAF V600E mutation in anaplastic thyroid carcinomas and their accompanying differentiated carcinomas. Br J Cancer. 2007;96(10):1549-53. PMid:17453004.

59 An JH, Hwangbo Y, Ahn HY, et al. A possible association between thyroid cancer and breast cancer. Thyroid. 2015;25(12):1330-8. PMid:26442580.

60 Tanaka H, Tsukuma H, Koyama H, Kinoshita Y, Kinoshita N, Oshima A. Second primary cancers following breast cancer in the Japanese female population. Jpn J Cancer Res. 2001;92(1):1-8. PMid:11173537.

61 Dong L, Lu J, Zhao B, Wang W, Zhao Y. Review of the possible association between thyroid and breast carcinoma. World J Surg Oncol. 2018;16(1):130. PMid:29976206.

62 Nielsen SM, White MG, Hong S, et al. The breast-thyroid cancer link: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2016;25(2):231-8. PMid:26908594.

63 Rappaport J. Changes in dietary iodine explains increasing incidence of breast cancer with distant involvement in young women. J Cancer. 2017;8(2):174-7. PMid:28243321.

64 Vannucchi G, De Leo S, Perrino M, et al. Impact of estrogen and progesterone receptor expression on the clinical and molecular features of papillary thyroid cancer. Eur J Endocrinol. 2015;173(1):29-36. PMid:25862786.

65 De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes. 2013;2013:291546. PMid:24073332.

66 Han JM, Kim TY, Jeon MJ, et al. Obesity is a risk factor for thyroid cancer in a large, ultrasonographically screened population. Eur J Endocrinol. 2013;168(6):879-86. PMid:23513231.

67 Goldgar DE, Easton DF, Cannon-Albright LA, Skolnick MH. Systematic population-based assessment of cancer risk in first-degree relatives of cancer probands. J Natl Cancer Inst. 1994;86(21):1600-8. PMid:7932824.

68 Ngeow J, Mester J, Rybicki LA, Ni Y, Milas M, Eng C. Incidence and clinical characteristics of thyroid cancer in prospective series of individuals with Cowden and Cowden-like syndrome characterized by germline PTEN, SDH, or KLLN alterations. J Clin Endocrinol Metab. 2011;96(12):E2063-71. PMid:21956414.

Submitted date:

Accepted date:

Publication date:

605ded15a95395240057a122 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections