Innumerable Radioiodine Negative Cutaneous Metastases From Papillary Thyroid Cancer
Bibliographic record
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and papillary thyroid carcinoma (PTC) accounts for a majority of these. Distant metastases, especially to the lung and bones, occur in about 10% of patients, who can still survive for many years. We report here the case of a 32 year old female who presented with multiple bilateral cervical lymphadenopathy, diagnosed as metastatic PTC on cytology. She underwent total thyroidectomy and bilateral radical neck dissection followed by radioiodine therapy. Subsequently she developed pulmonary and bone metastases, and during the course of successive radioiodine doses, presented with multiple, painless cutaneous and subcutaneous nodules which proved to be metastatic on cytopathology and immunostaining. Radioiodine uptake was not seen in these lesions, suggesting dedifferentiation of follicular cells. This case emphasizes three clinically important issues-firstly, although extremely rare, cutaneous nodules can represent metastatic PTC in patients with pre existing lung and bone lesions and portends a poorer prognosis. Secondly, these lesions may be dedifferentiated and hence not amenable to radioiodine therapy although the bone and lung lesions show radioiodine uptake. SPECT / CT helps us in determining if uptake of 131- I is in the skin lesions or underlying other sites. Redifferentiating agents may play a role in management of such disease. Lastly, immunostaining with CK19 and Thyroglobulin (Tg) can be highly useful to confirm the pathologic diagnosis. doi:10.4021/jem57w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".