Journal Information
Vol. 56. Issue 5.
Pages 328-329 (May 2020)
Vol. 56. Issue 5.
Pages 328-329 (May 2020)
Scientific Letter
Full text access
Endoscopic Diagnosis of Small Cell Lung Carcinoma and Follicular Thyroid Cancer
Diagnóstico endoscópico de carcinoma pulmonar de célula pequeña y neoplasia folicular de tiroides
Salomé Bellido-Calducha, Clara Martín-Ontiyueloa,b, Lara Pijuanc, Jaume Puig de Doud, Marina Suárez-Piñerae, Víctor Curulla,b, Albert Sánchez-Fonta,b,
Corresponding author

Corresponding author.
a Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UAB, CIBERES, ISCIII, Barcelona, Spain
b IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain
c Servei d’Anatomia Patològica, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
d Servei d’Endocrinologia i Nutrició, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
e Servei de Medicina Nuclear i Diagnòstic per Imatge, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
This item has received
Article information
Full Text
Download PDF
Figures (1)
Full Text
To the Editor,

We report the case of a 55-year-old male patient, an active smoker with a 60 pack-year history and previous intestinal polyposis, referred from another center due to the finding on routine chest radiograph of an image suggestive of lung cancer. Chest computed tomography (CT) showed a 57-mm left bilobar hilar lesion and a 40-mm right thyroid nodule. 18Fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) indicated active metabolism in both, with no mediastinal or extrathoracic involvement, suggesting a diagnosis of T3N0M0 lung cancer, and a hypermetabolic right thyroid nodule in the context of a nodular goiter which could correspond to a tumor or overactive nodule. Thyroid hormone levels requested for analysis of the thyroid nodule were normal. Fiberoptic bronchoscopy was performed, which identified an endobronchial tumor located in the left lower lobe bronchus. Biopsies were positive for small cell lung cancer (SCLC). As this was a patient with suspected lung cancer requiring treatment with radical intent, endobronchial ultrasound (EBUS) was performed simultaneously to complete the staging, using an Olympus BF-UC 180F ultrasonic bronchoscope (Olympus, Tokyo, Japan); no lymph nodes with ultrasound signs of malignancy were identified. Extrinsic compression was also observed in the upper third of the trachea due to the right nodular thyroid lesion, with hypoechoic areas inside. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)1 of the thyroid nodule was therefore carried out, revealing Hürthle cell follicular carcinoma and thus ruling out a pulmonary origin. Papanicolaou staining was used, as the samples were alcohol-fixed. In the case of the thyroid specimens, samples were air-dried for subsequent Giemsa staining for optimal evaluation. Given these results, it was decided to prioritize treatment of the SCLC, which was staged as T3N0M0 (Stage IIB); a chemotherapy regimen (cisplatin-etoposide) was therefore initiated with concomitant radiotherapy (total dose 64Gy). Meanwhile, the patient continued to have check-ups in endocrinology and, depending on the response of the lung cancer to treatment, hemithyroidectomy would be considered (Fig. 1).

Fig. 1.

Images A and B, corresponding to axial slices obtained in the 18F-FDG PET/CT study: (A) The images show pathological heterogeneous uptake of FDG, which is mapped onto the right thyroid nodule found in the CT scan. (B) Solid lesion with high FDG uptake in the left hilum with signs of lobular invasion. (C) Axial chest CT at cervical level, showing an increase in the nodular volume of the right thyroid lobe. (D) EBUS image of the right thyroid lobe. (E) TBNA of thyroid: uniform cell population of Hürthle cells distributed in a discohesive manner or in follicles, suggestive of Hürthle cell follicular carcinoma (Papanicolaou staining 40×). (F) Bronchial biopsy: small cell lung cancer (hematoxylin–eosin staining 20×).


Despite the high negative predictive value of 18F-FDG PET/CT—about 95% in mediastinal staging of lung cancer—histopathological confirmation using techniques such as EBUS-TBNA is necessary.1 The use of 18F-FDG PET/CT has highlighted a growing prevalence of thyroid lesions with increased uptake: 47% correspond to malignant disease, either primary or metastatic, mostly lung cancer, breast cancer or lymphoma.2,3 It is important to note that 18F-FDG uptake in the glandular tissue of the thyroid does not differentiate between benign or malignant lesions, so it is advisable to rule out a concomitant neoproliferative process.4.5

EBUS-TBNA is currently the most common procedure for mediastinal staging of non-SCLC, with sensitivity and specificity above 90% and well established safety and effectiveness.6 Sampling of all known mediastinal lesions in these patients confirms disease spread and determines the therapeutic strategy.7 When there is an incidental finding of thyroid lesions by 18F-FDG PET/CT, diagnostic confirmation is also recommended.8 In the thyroid, increased focal uptake is more suggestive of malignancy than diffuse uptake, so its study and follow-up are essential.5 Most thyroid nodules detected in patients with lung cancer are benign. Nevertheless, there are cases of thyroid metastases in these patients, which is why cytological confirmation is essential.9,10

So far, the technique used for sampling these lesions is ultrasound-guided fine needle aspiration biopsy (US-FNAB), or surgery if lesions are inaccessible. However, cases have been described in recent years where EBUS-TBNA has become a good alternative for minimally-invasive histopathological diagnosis of those lesions that are inaccessible or in patients with high surgical risk. The results are promising, and in the future, EBUS-TBNA could even become the diagnostic technique of choice.11–14

G.E. Darling, D.E. Maziak, R.I. Inculet, K.Y. Gulenchyn, A.A. Driedger, Y.C. Ung, et al.
Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial.
J Thorac Oncol, 6 (2011), pp. 1367-1372
S.C. Katz, A. Shaha.
PET-associated incidental neoplasms of the thyroid.
J Am Coll Surg, 207 (2008), pp. 259-264
R.F. Casal, M.N. Phan, K. Keshava, J.M. Garcia, H. Grosu, D.R. Lazarus, et al.
The use of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of thyroid lesions.
BMC Endocr Disord, 14 (2014), pp. 88
M. Barrio, J. Czernin, M.W. Yeh, M.F. Palma Diaz, P. Gupta, M. Allen-Auerbach, et al.
The incidence of thyroid cancer in focal hypermetabolic thyroid lesions: an 18F-FDG PET/CT study in more than 6000 patients.
Nucl Med Commun, 37 (2016), pp. 1290-1296
B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, et al.
2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.
Thyroid, 26 (2016), pp. 1-133
N. Navani, M. Nankivell, D.R. Lawrence, S. Lock, H. Makker, D.R. Baldwin, et al.
Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial.
Lancet Respir Med, 3 (2015), pp. 282-289
S.A. Thiryayi, D.N. Rana, N. Narine, M. Najib, S. Bailey.
Establishment of an endobronchial ultrasound-guided transbronchial fine needle aspiration service with rapid on-site evaluation: 2 years experience of a single UK centre.
Cytopathology, 27 (2016), pp. 335-343
A. Kumar, A. Mohan, S.S. Dhillon, K. Harris.
Substernal thyroid biopsy using endobronchial ultrasound-guided transbronchial needle aspiration.
J Vis Exp, (2014), pp. 1-9
A. Chow, M. Oki, H. Saka, S. Moritani, N. Usami.
Metastatic mediastinal lymph node from an unidentified primary papillary thyroid carcinoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration.
Intern Med, 48 (2009), pp. 1293-1296
A. Sánchez-Font, S. Peralta, V. Curull.
Diagnóstico de quiste tiroideo mediante ultrasonografía endobronquial sectorial con punción-aspiración en un paciente con cáncer de pulmón.
Arch Bronconeumol, 49 (2012), pp. 38-39
D.P. Steinfort, L.B. Irving.
Endobronchial ultrasound staging of thyroid lesion in small cell lung carcinoma.
Thorac Cardiovasc Surg, 58 (2010), pp. 128-129
M. Chalhoub, K. Harris.
Endobronchial ultrasonography with transbronchial needle aspiration to sample a solitary substernal thyroid nodule: a new approach.
Hear Lung Circ, 21 (2012), pp. 761-762
P. Li, W. Zheng, H. Liu, Z. Zhang, L. Zhao.
Endobronchial ultrasound-guided transbronchial needle aspiration for thyroid cyst therapy: a case report.
Exp Ther Med, 13 (2017), pp. 1944-1947
N. Filippi, E. Prisciandaro, J. Guarize, S.M. Donghi, G. Sedda, L. Spaggiari.
One-shot diagnosis: EBUS-TBNA as a single procedure for thyroid, pulmonary and lymph nodal lesions.
Adv Respir Med, 87 (2019), pp. 194-195

Please cite this article as: Bellido-Calduch S, Martín-Ontiyuelo C, Pijuan L, Puig de Dou J, Suárez-Piñera M, Curull V, et al. Diagnóstico endoscópico de carcinoma pulmonar de célula pequeña y neoplasia folicular de tiroides. Arch Bronconeumol. 2020;56:328–329.

Archivos de Bronconeumología
Article options

Are you a health professional able to prescribe or dispense drugs?