Tina Moazezi, D.O.: No financial relationships to disclose
Background: Papillary thyroid carcinoma (PTC) typically metastasizes to cervical lymph nodes, lung, and bone. Metastasis to the pancreas is exceedingly rare, with only isolated cases reported. Awareness of atypical metastatic patterns is essential for accurate diagnosis of recurrent disease, particularly in patients with complex oncologic histories.
Case Presentation: A 77-year-old man with prior thyroid marginal zone lymphoma (MALT) treated with radiation in 2019 was later found to have persistent thyroid PET activity and was diagnosed with PTC. He underwent total thyroidectomy in January 2020 (pT3N1) with residual MALT lymphoma and subsequently received radioactive iodine (RAI) ablation. Despite treatment, he developed evidence of progressive recurrent disease, including new pulmonary nodules suspicious for metastatic PTC. In November 2025, endoscopic ultrasound identified a 4.0 × 2.9 cm hypoechoic mass in the pancreatic neck. Given the patient’s history of pancreatic involvement by lymphoma, differential diagnosis included recurrent lymphoma, primary pancreatic malignancy, and metastatic thyroid carcinoma. Fine-needle biopsy demonstrated metastatic carcinoma consistent with thyroid origin based on morphologic features, immunohistochemistry, and clinical correlation. Serial cross-sectional imaging from 2024–2025 showed interval enlargement of the pancreatic lesion with extension toward the pancreatic head and associated distal pancreatic atrophy, consistent with progressive metastatic disease.
Conclusion: Pancreatic metastasis represents an exceptionally rare site of recurrence in papillary thyroid carcinoma and may mimic other pancreatic pathologies. This case underscores the importance of maintaining diagnostic suspicion for atypical metastatic presentations of differentiated thyroid cancer and highlights the role of tissue confirmation in guiding endocrine oncology management.
*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*
.jpg)
.jpg)
