Case report
Gastric Adenocarcinoma and Thyroid Follicular Adenoma with Oncocytic Features: A Rare Synchronous Presentation Managed with Single-stage Surgery
PD04-PD07
Correspondence
Suganya Palanivel,
12/25, SMV Koil Street, Triplicane, Chennai, Tamil Nadu, India.
e-mail: suganya.p.441993@gmail.com
Synchronous tumours involving anatomically and histologically distinct organs are uncommon and present considerable diagnostic and therapeutic challenges. The co-existence of gastric adenocarcinoma and a thyroid neoplasm is particularly rare. A 74-year-old male presented with vomiting, progressive abdominal fullness, anorexia, and significant unintentional weight loss. Upper gastrointestinal endoscopy revealed partial gastric outlet obstruction with a suspicious pyloric lesion. Contrast-Enhanced Computed Tomography (CECT) of the abdomen demonstrated circumferential wall thickening involving the pyloric region of the stomach causing significant luminal narrowing. During staging evaluation, Computed Tomography (CT) of the thorax incidentally detected a well-defined soft tissue lesion in the right lobe of the thyroid gland. Whole-body Positron Emission Tomography-Computed Tomography (PET-CT) demonstrated a heterogeneously enhancing metabolically active thyroid lesion with central necrosis and tracheal displacement, raising suspicion for malignancy. Core needle biopsy of the thyroid lesion suggested a follicular-patterned oncocytic neoplasm suspicious for Hurthle cell neoplasm. Following multidisciplinary tumour board discussion, the patient underwent D2 subtotal gastrectomy with regional lymphadenectomy followed by total thyroidectomy with preservation of three parathyroid glands in a single operative session. Histopathological examination of the gastric specimen revealed well-differentiated adenocarcinoma of the stomach pT3N1M0 {T3 (primary tumour), N1 (regional lymph node involvement), M0 (no distant metastasis)}. Histopathological examination of the thyroid lesion demonstrated follicular adenoma with oncocytic features without evidence of capsular or vascular invasion. Postoperatively, serum calcium and parathyroid hormone levels were monitored, and calcium supplementation was initiated. The patient subsequently received adjuvant chemotherapy for gastric carcinoma. The present case highlights the importance of comprehensive staging, histopathological confirmation, and multidisciplinary management in patients with suspected synchronous neoplastic lesions. Accurate differentiation between metastatic disease and a second primary or benign lesion is essential for appropriate therapeutic planning and prognostic assessment.