Key words tumor Vice syndrome; transfer of heat; hybrid medullary thyroid the follicular carcinoma;
Mixed medullary thyroid of follicular carcinoma the (Mixed medullary follicular carcinomas, MMFCs) is a rare tumor, this study reported one case of tumor fever as the first symptom mixed medullary thyroid the follicular carcinoma of lung metastasis patients and literature review.
1 Clinical data
Patients, male, 77 years old, the main cause of “bilateral thyroidectomy three months after two weeks with fever admitted to the hospital on September 10, 2004. Patients under general anesthesia on June 1, 2004 bilateral total thyroidectomy and neck regional lymph nodes wide excision. Pathologic report: (left) of mixed medullary thyroid follicular carcinoma and lymph node metastasis (5/29); (right) nodular goiter and multifocal mixed medullary follicular cancer, poorly differentiated carcinoma, lymph node metastasis (4/26). The two weeks before admission, patients with no obvious incentive fever as obvious to the afternoon, the temperature at 37.8 ℃ ~ 38.8 ℃, no chills, considering the possibility of the presence of infection given broad-spectrum antibiotics for two weeks of treatment, the meantime by the replacement of a variety of antibiotics invalid. Admission examination: body temperature 38.4 ° C, blood pressure 18.7/12 kPa, soft neck, no resistance, submandibular palpable and multiple lymph nodes, hard, poor activity, no tenderness. Laboratory tests: WBC 16.4 × 109 / L, neutrophils 88.6%, hemoglobin 117 g / L, 69.6 g / L, of the total protein, albumin 41 g / L, T3, T4, FT3, FT4 were within the normal range carcinoembryonic antigen (Carcinoembryonic antigen CEA), 25.34 ng / ml, CA19-9, AFP, CA125 were within the normal range. Abdominal B ultrasound: liver, gallbladder, pancreas, spleen, and kidneys were normal. Chest X-ray: the lungs can be seen scattered in flocculent shadows. Chest CT: multiple lung metastases. Blood, urine, stool and sputum cultures were negative. Application naproxen (250mg) can effectively control the patient’s temperature below 37 ℃. Rheumatoid Immunology and Hematology consultation to exclude related diseases, combination of medical history and laboratory tests to be considered persistent fever in patients with thyroid cancer, lung metastasis. Nine months of the patients died of extensive tumor metastasis.
MMFCs is a rare thyroid malignancy, accounting for 0.13% to 0.15% of all thyroid tumors, English literature since the 1980s, about 40 cases reported such cases [1,2]. Of mixed medullary thyroid follicular cancer histology on the structural features of medullary carcinoma and follicular carcinoma, calcitonin and thyroid tumor globulin immunohistochemical staining positive . The age distribution of patients in 26 to 74 years, with a median age of 48 years old. Visit most patients had lymph node metastasis, distant metastasis occurs mainly in the lungs, liver, mediastinum and bone , and sustained fever as the first symptom of thyroid cancer lung metastasis in the literature have not been reported. Some mixed medullary thyroid follicular carcinoma patients with elevated serum calcitonin related to tumor progression and biological behavior close to medullary thyroid carcinoma. Such as early detection is carried out on the basis of positive surgical adjuvant therapy, you may obtain superior to the effect of medullary thyroid cancer.
The patients in the diagnosis and treatment of process intractable fever, fever symptoms were not relieved, not found evidence of infection after broad-spectrum antibiotics, chest X-ray, CT, and CEA continues to rise to support the diagnosis of thyroid cancer, lung metastases, considered in patients with persistent fever is secreted by the tumor itself or metabolites resulting tumor vice syndrome . Clinically occult onset, performance is likely to be misdiagnosed as infection or fever caused by drug reactions, tumor fever  can be considered only after careful investigation and exclusion of other causes of fever. Application of non-steroidal anti-inflammatory drugs can be effective in controlling tumor febrile provide an important means of palliative care for patients .