Cytoreductive Surgery for Extensive Intra-Abdominal and Abdominal Wall Metastases from Papillary Thyroid Carcinoma: A Case Report and Review of the Literature.

Background

Papillary thyroid carcinoma (PTC) is typically associated with an excellent prognosis, and distant metastases are uncommon. When present, metastases most frequently involve the lungs and bones, while intra-abdominal dissemination is exceedingly rare and poorly characterized. The optimal management of such atypical metastatic patterns, particularly the role of surgery, remains undefined. Case Presentation: A 69-year-old female presented eight years after total thyroidectomy, cervical lymph node dissection, and radioactive iodine therapy for PTC with progressive abdominal pain, nausea, vomiting, and painful abdominal wall and bilateral inguinal masses. Imaging demonstrated extensive metastatic disease involving the anterior abdominal wall, gastrohepatic ligament, pelvis, retroperitoneum, diaphragm, urinary bladder, uterus, and inguinal lymph nodes, which was confirmed on biopsy as metastatic PTC. Serum thyroglobulin was markedly elevated at 473 µg/L. Given the bulky, symptomatic, and progressive disease refractory to prior radioactive iodine therapy, a multidisciplinary tumor board recommended cytoreductive surgery with palliative intent. The patient underwent resection of eleven major metastatic deposits over five hours without intraoperative complications, achieving complete macroscopic clearance of intra-abdominal disease. Histopathology confirmed metastatic PTC in all specimens. Postoperative serum thyroglobulin declined to 107 µg/L following surgery and adjuvant radioactive iodine therapy, and the patient reported complete resolution of abdominal symptoms at follow-up.

Conclusions

This case highlights the potential role of cytoreductive surgery as a palliative strategy in carefully selected patients with advanced intra-abdominal metastatic PTC. Such rare presentations underscore the importance of long-term surveillance and multidisciplinary decision-making. Further case accumulation is needed to better define optimal management strategies and patient selection criteria in this setting.