TRANSFORMATION TO UNDIFFERENTIATED FROM DIFFERENTIATED THYROID CANCER ASSOCIATED WITH REMARKABLE LEUKOCYTOSIS AND HYPERCALCEMIA-REPORT OF A CASE-

Abstract

A 63-year-old woman was admitted to the hospital because of appetite loss, dry mouth, and slight disturbance of consciousness on February 3, 1999. There was a previous history of undergoing a total thyroidectomy for differentiated thyroid cancer and multiple bone metastasis followed by TSH inhibition regimen and internal irradiation with ¹³¹I (3 times) in December 1995. Thereafter she had been followed up in our outpatient clinic until this admission. On admission, blood and biochemical examinations showed inflammatory findings and hypercalcemia. Chest x-ray film revealed multiple pulmonary metastasis. On ⁶⁷Ga scintigraphy, faint accumulation in the bilateral middle and lower lung fields and left iliac region were demonstrated. Histological findings of metastasized portion of the left iliac bone were not contradictory to those of undifferentiated cancer. In the clinical course after admission, the metastatic lung lesion abruptly enlarged, respiratory condition became worse, and the patient died on March 12, 1999. Increases in various serum cytokines such as G-CSF and PTHrP were confirmed that might cause inflammatory findings including leukocytosis and hypercalcemia.