Follicular and papillary carcinoma: a thyroid collision tumor

Synchronous papillary and follicular thyroid carcinomas: the first retrospective cohort study and literature review

Background

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) contribute to more than 95% of thyroid malignancies. However, synchronous PTC and FTC are less common; it is most commonly discovered incidentally as synchronous malignancies during operation, which adds difficulties to intraoperative decision-making and postoperative treatment. Therefore, we analyzed the clinicopathological characteristics and prognosis of patients with PTC and FTC in our center.

Methods

We conducted a search of single PTC, single FTC, and synchronous PTC/FTC patients who received initial surgery treatment at Fudan University Shanghai Cancer Center from 2006 to 2018 and collected paraffin-embedded samples of synchronous patients. Clinicopathological characteristics were collected from the electronic medical record system. Follow-up was performed through telephone contact or medical records. Exome sequencing was performed by ThyroLead panel.

Results

Total of 42 synchronous PTC/FTC patients, 244 single FTC patients, and 2,959 single PTC patients were included. It showed a similarity between the clinicopathological features of synchronous thyroid cancer patients and single PTC patients, with a greater proportion of females, higher probabilities of lymph node metastasis, and higher rate of concurrence of Hashimoto's disease. The disease-free survival (DFS) curve indicated a worse prognosis of the synchronous group and single PTC group compared to the single FTC group, who had a propensity for neck lymph node recurrence; however, logistic multivariate regression analysis did not find any factor related to recurrence in the synchronous group. After re-checking pathology, DNA extraction, and quality control, genetic alteration information of 62 samples including primary tumors and metastatic lymph nodes from 35 synchronous cancer patients was displayed. In total, 81 mutations and 1 fusion gene were identified, including mutations related to outcomes and targeted therapy. Besides, some rare mutations in thyroid cancer were found in these patients.

Conclusions

To conclude, synchronous PTC/FTC tend to be incidentally discovered during or after operation, behaving more like single PTC. The prognosis of synchronous patients is worse than that of single FTC patients and supplemental cervical lymph node dissection, total thyroidectomy, and postoperative radioiodine therapy should be taken into consideration after diagnosis. The next-generation sequencing (NGS) showed a unique molecular feature of synchronous patients with some rare mutations.

A patient with a rare co-occurrence of papillary and follicular thyroid carcinomas

The occurrence of papillary and follicular thyroid carcinoma as a collision tumor is rare. We report on a case of a collision tumor consisting of papillary and follicular thyroid carcinoma treated successfully with surgery and radioiodine ablation.

Synchronous Papillary and Follicular Carcinoma with Scalp and Nodal Metastasis: A case report with review of literature

Collision tumor comprise of existence of two histologically distinct and separate neoplasms in any organ. Thyroid gland is an uncommon site for these tumors, with frequently involved organs being liver, adrenal and stomach. Even among the synchronous tumors of thyroid, papillary and medullary carcinoma are most commonly reported. The present case reports a rare presentation of a collision tumor comprising of papillary and follicular carcinoma with scalp metastasis from the follicular carcinoma and lymph nodal metastasis from the papillary component. It is essential for the clinician to be aware of such an entity so as to guide further treatment and management.

Case reports of collision and composite carcinomas of the thyroid: an insight into their origin and clinical significance

BACKGROUND

Collision and composite carcinomas of the thyroid are extremely rare, and their clinical and biological characteristics are poorly understood.

CASE PRESENTATION

The first case was a 41-year-old female patient with a right thyroid nodule. Pathological diagnosis was papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma composite carcinoma. Surgical treatment was right thyroid lobectomy + left partial thyroidectomy + right central neck lymph node dissection. The second case was a 60-year-old female with bilateral thyroid nodules. Total thyroidectomy was performed, and the pathological diagnosis was thyroid collision carcinoma involving follicular thyroid carcinoma on the left side and PTC on the right side. The clinical, histological and gene changes of collision and composite carcinomas of the thyroid are poorly described. With different biological invasion characteristics, the ideal treatment and the prognosis is currently unknown and individualized treatment is necessary.

CONCLUSIONS

It is recommended that in composite carcinoma, each cancer is evaluated and treated according to the most severe tumor. Collision carcinoma should be treated as two separate synchronous primary tumors. For both collision and composite carcinomas of the thyroid, the follow-up after treatment should be extensive.

Collision tumor of a papillary and follicular thyroid carcinoma: a case report

BACKGROUND

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are common differentiated thyroid cancers, but the detection of a collision tumor is an extremely rare event.

CASE PRESENTATION

The patient was a 69-year-old Japanese female with multiple cervical lymph node swellings and a thyroid tumor. Preoperative fine needle aspiration cytology of the enlarged lymph node revealed a cytological diagnosis of papillary thyroid carcinoma (PTC). A total thyroidectomy, right cervical dissection and paratracheal dissection were performed. Histopathological and immunohistochemical analyses of resected specimens revealed a collision tumor of PTC and FTC. Multiple metastases of papillary carcinoma were found in the dissected lymph nodes. In the PTC lesion, IHC for BRAF (V600E) was positive but negative for the FTC lesion. Genetic analyses further revealed a TERT promoter C228T mutation in PTC and a NRAS codon 61 mutation in FTC. The patient died of recurrent cancer 8 months after surgery.

CONCLUSIONS

A case of a collision tumor of PTC and FTC is very rare, and even fewer cases have been subjected to genetic scrutiny. The present case was successfully diagnosed by pathological examination using immunohistochemical and genetic analyses. The TERT promoter mutation in the PTC lesion was consistent with the aggressive behavior of the cancer.

Clinicopathological features and prognostic factors analysis of multiple synchronous distinct subtypes of primary thyroid carcinoma

PURPOSE

To investigate the clinicopathological features, diagnosis, treatment, and prognosis of multiple synchronous distinct subtypes of primary thyroid carcinomas.

METHODS

The clinical data of 68 cases of synchronous carcinomas of the thyroid (STC) admitted to the Department of Thyroid Surgery in our hospital from January 2013 to December 2021 were reviewed. According to the pathological type, they were divided into the Synchronous differentiated and differentiated thyroid Carcinoma (SDDTC) group (42 cases), the Synchronous medullary and differentiated thyroid Carcinoma (SMDTC) group (18 cases), and the Synchronous Anaplastic and differentiated thyroid Carcinoma (SADTC)group (8 cases). The diagnosis, treatment, and survival of patients in each group were analyzed.

RESULTS

Women with coexisting thyroid cancer were predominant (59 cases). Most of the symptoms were found on physical examination (47.1%) and neck mass (45.6%). The median age of patients in the SDDTC group, SADTC group, and SMDTC group was 47.5 (28-74) years old, 68.5 (26-75) years old, and 56.5 (39-74) years old. The age of the SADTC group and SMDTC group was older than that of the SDDTC group (P = 0.04, P = 0.03), and the rate of lymph node metastasis in groups SADTC (62.5%) and SMDTC (55.6%) was higher than in group SDDTC (21.4%). The disease course time, tumor location, clinical stage, and mortality of the SADTC group were significantly different from those of the SDDTC group and SMDTC group (P < 0.05). The overall survival of patients with synchronous carcinomas of the thyroid was 6-105 months, and the median overall survival was 38.5 months. The tumor-free survival was 0-90 months, 19.1% of patients developed distant metastasis, 11.8% of patients had postoperative recurrence, as well as the survival rate was estimated 91.18%. Cox model multivariate analysis showed that cervical lateral lymph node metastasis and tumor stage III/IV were independent risk factors for progression-free survival(PFS). The comparison results of the survival curves showed that the overall survival (OS)of the patients in the SADTC group was significantly worse (P < 0.01), while there was no significant difference in the PFS of different pathological types (χ2 = 5.024, P = 0.081).The OS of different treatment methods was significantly different (P = 0.002), but there was no significant difference in OS between local recurrence and distant metastases with or without surgery (χ2 = 0.954, P = 0.329).

CONCLUSIONS

The STC has relatively unique clinical characteristics, and most patients can get a better prognosis after radical surgery. Pathological type, lateral cervical lymph node metastasis, tumor stage, and treatment are important factors which affect the prognosis of the disease. Since there are two distinct tumors with different aggressiveness, treatment options, and prognosis, individualized management is required.

A unique case of anaplastic thyroid carcinoma comprising of two distinct patterns osteoclastic variant and squamous cell carcinoma in separate lobe imitating collision tumor: A case report

Anaplastic thyroid carcinoma with two distinct morphologies in two lobes with no intermixing is very rare and not reported earlier. Furthermore, osteoclastic variant of anaplastic thyroid carcinoma as well as primary squamous cell carcinoma without any differentiated components are also very rare with only few reported cases describing their cytological features. Herein, we are reporting a unique and first case of anaplastic thyroid carcinoma comprising of two distinct patterns osteoclastic variant and squamous cell carcinoma in different lobes in a 55-years-old lady with review of literature.

Thyroid Collision Tumors: The Presence of the Medullary Thyroid Carcinoma Component Negatively Influences the Prognosis

Thyroid collision tumors (TCTs) are rare pathological findings, representing <1% of thyroid cancers. This study aimed to compare the main pathological features of TCTs containing medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) components with MTC-only tumors and PTC-only tumors. Methods: The retrospective study included 69 cases diagnosed with TCTs (with simultaneous MTC and PTC components), MTC and PTC. All tumors were comparatively assessed for the classical histopathological prognostic features, including a new grading system for MTC. Results: The main component of TCTs had more frequent microscopic extrathyroidal extension (mETE) (p = 0.000), lymphovascular invasion (LVI) (p = 0.000), perineural invasion (PNI) (p = 0.044), and lymph node metastasis (p = 0.042). Additionally, the TCTs’ MTC component presented with more frequent LVI (p = 0.010). Comparing TCTs’ MTC and PTC components with MTC-only tumors and PTC-only tumors revealed that only the TCTs’ MTC components had statistically significant more frequent mETE (p = 0.010) than MTC-only tumors. When applied to the MTC component of TCTs, the pathological parameters of the new grading system of MTC showed no correlations with other microscopic or clinical aspects. Conclusion: Using classical pathological prognostic features, the comparative analysis revealed that the main TCTs’ component was more aggressive than the minor one. Contrary to PTCs, in TCTs, the medullary component was more aggressive than the papillary one, but also more aggressive than MTC-only tumors.

Thyroid collision tumors; A case series with literature review

Background

Collision tumors are two histologically distinct types of malignancies within the same mass and organ. The aim of this study is to present a case series of thyroid collisions.

Methods

This was a multicenter retrospective case series study. The participants were consecutive in order. Socio-demographic and clinical data were obtained from hospital records.

Results

The study included eight cases comprising six (75%) females and two (25%) males. The patients had different presentations, including neck swelling, dyspnea, and dizziness. The pathology was successfully determined through fine-needle aspiration. Four patients (50%) underwent lobectomy, whereas the other half (four patients) underwent total thyroidectomy.

Conclusion

Collision tumors of papillary thyroid cancer (PTC) and follicular thyroid carcinoma (FTA) or medullary thyroid carcinoma (MTC) and FTA are exceedingly rare phenomena that most commonly affect females. Complete or partial thyroidectomy is the ideal management of choice for these cases and is associated with good survival.

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Collision tumors are two distinct types of malignancies with dissimilar cellular lineages and genetic origins within the same mass.

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Patients with thyroid collision tumors have rarely been observed in the literature.

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Most thyroid collision tumors consisting of papillary and medullary carcinoma.

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In this study, several cases of thyroid collision tumors have been discussed.

Collision tumors of the thyroid. A special clinical and pathological entity

Thyroid collision tumors are rare entities that designate two histologically and morphologically distinct tumors that occur simultaneously or as metastases from other organs within the thyroid. Medullary and papillary carcinoma co-occurrence is the most frequent. Several theories tried to explain the pathogenic mechanisms underlining collision tumors, including the theory which assumes that one tumor predisposes the other, stem cell theory, and random effect theory, but their combination better explains the origin of these tumors. Hypotheses about common genetic behavior responsible for the pathogenesis have also been suggested, such as the involvement of germline mutation of RET (Rearranged during Transfection) proto-oncogene in medullary thyroid carcinoma and papillary thyroid carcinoma coexistence, but there is controversy on this topic. Management of thyroid collision tumors is challenging owing to the presence of two distinct tumors with different biological aggressiveness, treatments options, and prognosis, and needs to be individualized.

Thyroid collision tumor containing oncocytic carcinoma, classical and hobnail variants of papillary carcinoma and areas of poorly differentiated carcinoma

Collision tumors are rare and may comprise components with different behavior, treatments, and prognosis. We report an unprecedented case of aggressive thyroid collision tumor containing widely invasive oncocytic carcinoma (OC), classical and hobnail (HPTC) variants of papillary carcinoma, and poorly differentiated carcinoma (PDTC). The patient underwent total thyroidectomy, radioactive iodine therapy, and within months progressed with local recurrence, and pulmonary metastases requiring neck dissection, external radiotherapy and systemic treatment with sorafenib. The rapid progression, dedifferentiated metastatic lesions, and failure to treatments resulted in the patient's death. The great variety of histological types and the evolution of this case were a challenge for the management of metastatic disease. Widely invasive OC, HPTC and PDTC are considered to have a worse prognosis. HPTC has never been reported as a component of a collision tumor. HPTC and PDTC should call attention to a possible higher-grade transformation.

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases

BACKGROUND

Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia.

METHODS

This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients' sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system.

RESULTS

A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31-50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer.

CONCLUSIONS

Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.

Simultaneous occurrence of follicular and papillary thyroid carcinomas in same thyroid lobe: A case series of six patients from Qatar

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Simultaneous occurrence of papillary and follicular thyroid carcinomas in the same lobe are very rare.

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First case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region.

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Endocrinologists and pathologists should be aware of and vigilant to this variety.

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Occurrence of both types together shifts patients from low risk to intermediate or high risk which may reflect on management.

Background

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported.

Presentation of cases

We report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region.

Conclusions

We present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety.

Coexistence of Two Different Thyroid Malignancies: A Collision Phenomenon

The term “collision tumor” is described as the coexistence of two or more histologically distinct neoplastic morphologies separated by normal tissue in the same organ. Simultaneous papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) of the same thyroid lobe is a very rare pathology. Herein, we report a case of PTC and FTC of the same thyroid lobe. A 79-year-old man was evaluated at our hospital for the presence of left hip pain of two-month duration after sustaining a physical trauma to the left side of his body three days prior to admission. X-ray imaging of the left femur revealed a large lytic bony lesion at the proximal end of left femur. Biopsy of the bone lesion was suggestive of FTC. Computed tomography (CT) of the neck revealed an enlarged thyroid with a cystic lesion in the left lobe of the thyroid gland. Total thyroidectomy was performed. Histopathology revealed two separate primary malignancies of PTC and FTC. Genetic studies for RAS gene mutation were negative. He was initiated on suppressive doses of levothyroxine following thyroidectomy. Three months after surgery, thyrotropin alfa stimulated 204.5 mCi I-131 was administered. At seven months of follow-up, the thyroglobulin level was in the lower end of the normal range and anti-thyroglobulin antibody (anti Tg) remained negative (< 1.0 IU/mL). He was doing well and reported no symptoms.

For each type of well-differentiated thyroid cancers, several genes have been identified. However, thus far, no specific gene mutation responsible for the pathogenesis of the different tumor types has been described. Management of thyroid collision tumor is usually complex due to the presence of different pathology in the tumor tissues and given the fact that literature on this condition is limited. Typically, the treatment needs to be individualized. Our report brings up a concept that the occurrence is a rare phenomenon of simultaneous mutation of different genes that could give rise to different thyroidal neoplasms.

Concurrence of Papillary Thyroid Carcinoma and Hürthle Cell Carcinoma in an Iranian Woman with Hashimoto's Thyroiditis

The most usual form of the endocrine carcinoma is thyroid cancer (TC). In addition to papillary thyroid carcinoma (PTC), recent studies revealed incidence of RET/PTC rearrangement in other tumors, like Hürthle cell carcinoma (HCC) and even in non-carcinomatous disorders like Hashimoto's thyroiditis. Here, we present a case with concurrence of papillary thyroid carcinoma and Hürthle cell carcinoma.

A 60-year-old woman referred to our hospital with a mass in her neck. Physical examinations revealed painful swelling in the thyroid. Ultrasonographic examination showed two hypoechoic nodules in the right lobe. Hürthle cell variant papillary carcinoma was suggested in the cytology report of the fine needle aspiration. Permanent histopathological diagnosis was co-existence of papillary thyroid carcinoma and Hürthle cell carcinoma. The patient was asymptomatic in 14 months follow up.

Concurrence of papillary carcinoma and Hürthle cell carcinoma is a rare form of thyroid malignancies, with doubtful cytogenetic findings and biological behaviors. The results showed that it is necessary for the surgeons and pathologists to be aware of lesions for the optimal diagnostic and therapeutic interventions. Also, it is vital to follow up patients with the Hashimot’s thyroiditis who have multiple nodules to detect occult thyroid cancers and decide for better therapeutic programs.

Collision carcinoma of squamous cell carcinoma and small cell neuroendocrine carcinoma of the larynx: A case report and review of the literature

BACKGROUND

Collision carcinoma is rare in clinical practice, especially in the head and neck region. In this paper, we report a case of squamous cell carcinoma (SCC) and neuroendocrine carcinoma (NEC) colliding in the larynx and review 12 cases of collision carcinoma in the head and neck to further understand collision carcinoma, including its definition, diagnosis, and treatment.

CASE SUMMARY

A 61-year-old man presented with a 1-year history of hoarseness. Contrast-enhanced magnetic resonance imaging of the larynx revealed that the right vocal cord had a nodule-like thickening with obvious enhancement. Laryngoscopy revealed a neoplasm on the right vocal cord, and a malignant tumor was initially considered. A frozen section of right vocal cord was performed under general anesthesia. The pathological result showed a malignant tumor in the right vocal cord. The tumor was excised with a CO₂ laser (V_c type). Routine postoperative pathology showed moderately differentiated SCC with small cell NEC in the right vocal cord. No metastatic lymph nodes or distant metastases were found on postoperative positron emission tomography/computed tomography. Because of the coexistence of SCC and NEC, the patient received adjuvant chemotherapy and radiotherapy. The patient was followed for 8 mo, and no recurrence or distant metastasis was found.

CONCLUSION

The treatment of collision carcinoma in the head and neck region is uncertain due to the small number of cases.

Encapsulated Follicular Variant of Papillary Thyroid Carcinoma Arising in a Follicular Adenoma: a Diagnostic Dilemma

Papillary thyroid carcinoma (PTC) arising within follicular adenoma is a rare histological subset of papillary carcinoma. A 24-year-old female (euthyroid and asymptomatic) presented with a solitary mass in the right lobe of thyroid for 2 years. Fine-needle aspiration cytology (FNAC) suggested features of hyperplasia of thyroid. Hemithyroidectomy was performed. Histopathological examination revealed two distinct areas and was reported as encapsulated variant of papillary carcinoma along with follicular adenoma. Papillary carcinoma was confirmed by positive immunohistochemistry for HBME-1. CT head and neck region ruled out metastasis and the patient was kept on follow-up. There have been reports of medullary and papillary carcinomas occurring together; however, there is a paucity of literature on co-existing follicular neoplasm and papillary carcinoma. We hereby report a rare case of follicular variant of papillary carcinoma arising within follicular adenoma of the thyroid.

Clinicopathological profile of papillary carcinoma of thyroid: A 10-year experience in a tertiary care institute in North Karnataka, India

CONTEXT

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy accounting for 80% of the thyroid cancers. Many histopathologic variants of PTC have been recognized, and few of these are of prognostic significance. The studies on clinicopathological features of PTC and its variants are so far seldom reported in India.

AIM

The aim of the study was to study the percentage distribution of PTC among total thyroid specimens, the age and sex distribution of PTC, its histopathological features including frequency of nuclear findings, and various histological subtypes are also studied in detail. Methods: All cases of PTC diagnosed in our department from April 2003 to March 2013 formed the material for the study. The tissues were routinely processed and stained. On microscopic examination, tumors were classified according to 2004 WHO classification.

RESULTS

PTC formed the predominant type of malignancy accounting to 71% of the total cases. Of these, about 75% of patients were in the second to fifth decade. Male to female ratio was 1:5.4. Other than the usual classic variant and follicular variant, we also found rare types such as clear cell variant, tall cell type, oncocytic type, and macrofollicular variant. Microscopically, nuclear overcrowding and ground glass nuclei were seen in more than 90% of cases. Nodular goiter, Hashimoto's thyroiditis, and follicular adenoma were associated lesions in some cases.

CONCLUSION

PTC is the most common thyroid malignancy, and it can affect any age group though it presents mostly in the third to fourth decade of life. Recognition of histological subtype is crucial in patient prognosis.

Synchronous and Metastatic Papillary and Follicular Thyroid Carcinomas with Unique Molecular Signatures

Despite the relatively high prevalence of thyroid cancer, the occurrence of multiple synchronous, distinct subtypes of primary thyroid carcinoma is uncommon. The incidental finding of papillary thyroid microcarcinoma in a gland with a biologically relevant follicular or medullary carcinoma is more frequent than the synchronous occurrence of multiple clinically significant carcinomas. We report a case of synchronous papillary and follicular thyroid carcinomas metastatic to lymph node and bone, respectively. Next generation sequencing showed BRAF V600E mutation in the primary papillary carcinoma and NRAS Q61R mutation in the primary follicular carcinoma and bony metastasis. To our knowledge, this is the first reported case of synchronous and metastatic primary papillary and follicular carcinomas, and the first report of synchronous BRAF V600E mutated papillary and NRAS mutated follicular carcinoma.