Síndrome de Vena Cava Superior Secundario a Carcinoma Folicular Tiroideo Diferenciado de Alto Grado

Síndrome de Vena Cava Superior Secundario a Carcinoma Folicular Tiroideo Diferenciado de Alto Grado

Superior Vena Cava Syndrome Secondary to High-Grade Differentiated Follicular Thyroid Carcinoma

Silvia Sánchez Infante-Carriches*, Tamara Díaz Vico*/**, Irene Grao Torrente*, Manuel Durán Poveda*/**

* Servicio de Cirugía General y del Aparato Digestivo.
     Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
** Departamento de Especialidades Médicas y Salud Pública,
    Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España

DOI: https://doi.org/10.14679/5176

Resumen:

Introducción El carcinoma folicular de tiroides (CFT) es el segundo subtipo más frecuente de carcinoma diferenciado de tiroides y se caracteriza por su tendencia a la invasión vascular y la diseminación hematógena. No obstante, la afectación de grandes vasos, como la vena cava superior (VCS), es excepcional y supone un reto quirúrgico de gran complejidad.
Caso clínico Varón de 65 años con edema facial, cervical y palpebral de cuatro meses de evolución. La tomografía axial computarizada evidenció un bocio multinodular con componente endotorácico derecho y una masa mediastínica de gran tamaño, asociada a trombosis tumoral crítica de la VCS y la vena yugular interna. La punción-aspiración con aguja fina confirmó un carcinoma diferenciado de alto grado de origen folicular. Ante el riesgo de tromboembolismo pulmonar fatal, se realizó cirugía mediante abordaje cervico-torácico combinado y asistencia con circulación extracorpórea (CEC), practicándose tiroidectomía total, resección de la masa mediastínica y reconstrucción de la VCS con parche de pericardio bovino.
Conclusión El síndrome de VCS secundario a CFT constituye una complicación extremadamente rara y potencialmente mortal. Este subtipo de carcinoma diferenciado de alto grado presenta un comportamiento biológico agresivo, con invasión extratiroidea, afectación vascular y elevada tasa de recurrencia. Aunque las metástasis a distancia son más habituales, la invasión directa de grandes vasos es excepcional. Este caso demuestra que la afectación de la VCS no contraindica la cirugía en CFT avanzado. Un abordaje quirúrgico multidisciplinario puede mejorar la sintomatología y el control local de la enfermedad.
Palabras Clave: carcinoma folicular de tiroides; carcinoma folicular diferenciado de alto grado; síndrome de vena cava superior; trombosis tumoral.

Abstract:

Introduction Follicular thyroid carcinoma (FTC) is the second most common subtype of differentiated thyroid carcinoma and is characterized by its tendency for vascular invasion and hematogenous dissemination. However, invasion of major vessels such as the superior vena cava (SVC) is extremely rare and represents a complex surgical challenge.
Case report A 65-year-old man presented with facial, cervical, and palpebral edema of four months’ duration. Computed tomography revealed a multinodular goiter with a right endothoracic component, and a large mediastinal mass associated with critical tumor thrombosis of the SVC and internal jugular vein. Fine-needle aspiration confirmed a high-grade differentiated follicular carcinoma. Due to the risk of fatal pulmonary embolism, a combined cervicothoracic approach with extracorporeal circulation assistance was performed, including total thyroidectomy, mediastinal mass resection, and SVC reconstruction with a bovine pericardial patch.
Conclusion SVC syndrome secondary to FTC is an extremely rare and potentially life-threatening complication. This high-grade differentiated subtype exhibits aggressive biological behavior, with extrathyroidal invasion, vascular involvement, and a high recurrence rate. Although distant metastases are more common, direct invasion of major vessels is exceptional. This case demonstrates that SVC involvement does not contraindicate surgery in advanced FTC. A multidisciplinary surgical approach may improve symptoms and local disease control.
Key words: follicular thyroid carcinoma; high-grade differentiated carcinoma; superior vena cava syndrome; tumor thrombosis.

Bibliografía

1. 1. 1. Ashorobi D, Anastasopoulou C, Lopez PP. Follicular Thyroid Cancer. 2023 Feb 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
      2. Management of Poorly Differentiated Thyroid Cancer and Differentiated High-Grade Thyroid Carcinoma. Surg Clin North Am 2024; 104 (4): 751-765.
      3. Chen W, Lei J, Wang Y, Tang X, Liu B, Li Z, Zhou Q. Case Report: Superior Vena Cava Resection and Reconstruction for Invasive Thyroid Cancer: Report of Three Cases and Literature Review. Front Surg 2021 Jun 1; 8: 644605.
      4. Jung CK, Bychkov A, Kakudo K. Update from the 2022 World Health Organization Classification of Thyroid Tumors: A Standardized Diagnostic Approach. Endocrinol Metab (Seoul) 2022 Oct (4); 37(5): 703-718.
      5. Xu B, David J, Dogan S, Landa I et al. Primary high-grade non-anaplastic thyroid carcinoma: a retrospective study of 364 cases. Histopathology 2022; 80: 322-337.
      6. Jeong S.I., Kim W., Yu H.W., et. al.: Incidence and Clinicopathological Features of Differentiated High-Grade Thyroid Carcinomas: An Institutional Experience. Endocr Pathol 2023; 34: pp. 287-297.
      7. Xu MS, Li J, Wiseman SM. (2018). Major vessel invasion by thyroid cancer: a comprehensive review. Expert Review of Anticancer Therapy 2019 19 (2), 191-203.
      8. René Mercy PY, Thariat J, Bozec A et al. Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute Experience. Word J Surg Oncol 2009 Apr 17; 17: 40.
      9. Chen W, Lei J, Wang Y et al. Case Report: Superior Vena Cava Resection and Reconstruction for Invasive Thyroid Cancer: Report of Three Cases and Literature Review. Front Surg 2021 Jun 1; 8: 644605.