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Rodrigo-Gómez L, Pardal-Refoyo JL, Batuecas-Caletrío Á. Prevalencia de tumores metastásicos en la glándula tiroides. Revisión sistemática y metanálisis. REVISTA ORL 2020. [DOI: 10.14201/orl.23207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: Los tumores metastásicos en la glándula tiroides complican el diagnóstico, el tratamiento y el pronóstico del paciente. El objetivo es conocer la prevalencia de las metástasis en la glándula tiroides referida en la literatura médica y los tumores primarios que con más frecuencia metastatizan en la glándula tiroides. Método: Se realizó una revisión bibliográfica sistemática en las bases de datos de PubMed, La Biblioteca Cochrane y Scopus. Los artículos seleccionados se dividieron en dos grupos, series clínicas de pacientes en los que se hallaron metástasis en tiroides (grupo A) y series de hallazgos de metástasis en tiroides en autopsias (grupo B). Se realizó metanálisis de prevalencia para cada grupo de artículos siguiendo el modelo de efectos aleatorios. Resultados: La prevalencia en cada grupo con su índice de confianza al 95% fue 0.00479 (0.002-0.007) para el grupo A y 0.0362 (0.014-0.059) para el grupo B. La prevalencia de metástasis halladas en autopsias fue 7,58 veces mayor que en los estudios clínicos. En el grupo A la edad media fue 60.82 y en el grupo B 57.20. En ambos grupos las metástasis halladas en tiroides fueron más frecuentes en el sexo femenino. La localización del tumor primario fue diferente en ambos grupos, en el grupo A fue el cáncer de riñón y en el grupo B el cáncer de mama. La variabilidad de la prevalencia de metástasis en tiroides en los diferentes artículos de ambos grupos hace que este estudio tuviese una alta heterogeneidad (índice I2 y Q). Los funnel plot de ambos grupos indicaron alto sesgo de publicación. Discusión: La diferente prevalencia entre series clínicas y autopsias puede implicar que la detección de metástasis en tiroides en la clínica está infradiagnosticada. La razón de esto podría ser que las metástasis intratiroideas se presentan de forma asintomática siendo diagnosticadas como hallazgo casual en autopsias. En otras ocasiones se presentan como un nódulo tiroideo años después del tumor primario, lo que condiciona el diagnóstico. Conclusiones: La prevalencia de metástasis en tiroides es superior en las series de autopsias que en series clínicas (hasta 6.67 veces más frecuente en nuestro estudio). Las metástasis intratiroideas probablemente están infradiagnosticadas por cursar sin clínica siendo diagnosticadas como hallazgo casual en autopsias. Los tumores primarios más frecuentes fueron el riñón (series clínicas) y la mama (series de autopsias).
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Cesaretti M, Trotta M, Varaldo E, Ansaldo G, Leale I, Borgonovo G. Metastases to the thyroid gland from renal cancer. TUMORI JOURNAL 2018; 99:e107-10. [DOI: 10.1177/030089161309900327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aims and background Metastases to the thyroid gland from renal cancer pose a challenge to physicians, due in part to the rarity of the phenomenon, the prolonged time interval between removal of the primary renal cancer and the appearance of metastases, the difficulty in diagnosis, and the uncertainty regarding long-term prognosis. We report our experience with diagnosis and management of patients affected by thyroid metastases from renal clear cell carcinoma. Study design We report herein three clinical cases of thyroid metastases from renal clear cell carcinoma. We also present a review of the literature and examine common features of clinical presentation and management recommendations. Results Over the past 17 years, 918 patients underewent surgery for thyroid cancer in our institution. Histological examination demonstrated a thyroid secondary malignancy from kidney cancer in 3 cases. Two patients underwent total thyroidectomy, whereas in the third patient a palliative right lobectomy with homolateral latero-cervical lymphoadenectomy was performed. At a 5-year follow-up, only one patient survived and was disease-free. Conclusions Thyroid metastases from renal clear cell carcinoma are a rare occurrence but should be taken into consideration in the differential diagnosis of a thyroid nodule. Preoperative diagnosis is often difficult. Nevertheless, an extensive diagnostic workup is recommended because the subsequent therapy must be tailored on the basis of the local extension of metastases. Surgical treatment of solitary thyroid metastases is recommended. However, patients with disseminated disease have a poor prognosis, and palliative care is the indicated recommendation. In these patients and in surgically untreatable patients, prolonged survival may be achieved by adjuvant medical therapy.
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Affiliation(s)
- Manuela Cesaretti
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Manuela Trotta
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Emanuela Varaldo
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Gianluca Ansaldo
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Irene Leale
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Giacomo Borgonovo
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
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Thiam I, Doh K, Hassan-Farah S, Tagba E, Leloua A, Woto-Gaye G. [Intra-thyroid metastasis and the pathologist]. Ann Pathol 2017; 37:170-174. [PMID: 28291559 DOI: 10.1016/j.annpat.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/06/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
Intra-thyroid metastases (ITM) are rarely observed clinically. The high blood flow of the thyroid and its high content of iodine explain this rarity. The clinical and radiological criteria of ITM are not very specific. The pathologist is the principal actor of ITM diagnosis. Cytology, intraoperative examination and histological techniques are the means available. The microscopic aspects of ITM are varied. Art is to differentiate ITM to undifferentiated primary tumor. We report two cases of ITM in patients aged 49 and 52 years, respectively. We discuss diagnostic methods and challenges for pathologists in identifying such lesions.
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Affiliation(s)
- Ibou Thiam
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal.
| | - Kwame Doh
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal.
| | - Samatar Hassan-Farah
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal.
| | - Essolam Tagba
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital régional de Ziguinchor, Ziguinchor, Sénégal
| | - Adolph Leloua
- Service d'urologie-andrologie, hôpital Général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - Gisèle Woto-Gaye
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal
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4
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Diffuse thyroid metastases and bilateral internal jugular vein tumor thrombus from renal cell cancer. Radiol Case Rep 2016; 11:434-437. [PMID: 27920875 PMCID: PMC5128382 DOI: 10.1016/j.radcr.2016.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/29/2016] [Indexed: 11/27/2022] Open
Abstract
Renal cell cancer rarely metastasizes to the thyroid gland, and it has been reported to present as a solitary mass. We present a case of diffuse thyroid cancer metastases from renal cell cancer. Bilateral internal jugular vein tumor thrombi were also present. To the best of our knowledge, this is the first description of diffuse thyroid metastases from renal cell cancer in the English literature. Renal cell cancer metastases should be considered in the differential of thyroid imaging abnormalities arising in the setting of known renal cell carcinoma, particularly late in the course of disease. This is frequently associated with internal jugular vein thrombi, which should be evaluated with an abnormal thyroid. Thyroglobulin levels are usually normal in such patients.
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Bex A. Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma. EJC Suppl 2015. [PMID: 26217128 PMCID: PMC4041303 DOI: 10.1016/j.ejcsup.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands
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Ramírez-Plaza CP, Domínguez-López ME, Blanco-Reina F. Thyroid metastasis as initial presentation of clear cell renal carcinoma. Int J Surg Case Rep 2015; 10:101-3. [PMID: 25827295 PMCID: PMC4429947 DOI: 10.1016/j.ijscr.2015.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 12/28/2022] Open
Abstract
Thyroid metastases from other primary are exceptional. When present, a therapeutic approach in order to cure is still feasible for the primary tumor. Diagnosis of thyroid metastasis is difficult if not kept in mind. Renal tumors are frequently metastatic at the time of diagnosis.
Introduction Metastatic tumors account for 1.4–2.5% of thyroid malignancies. About 25–30% of patients with clear cell renal carcinoma (CCRC) have distant metastasis at the time of diagnosis, being the thyroid gland a rare localization [5%]. Presentation of the case A 62-year woman who underwent a cervical ultrasonography and a PAAF biopsy reporting atypical follicular proliferation with a few intranuclear vacuoles “suggestive” of thyroid papillary cancer in the context of a multinodular goiter was reported. A total thyroidectomy was performed and the histology of a clear cell renal carcinoma (CCRC) was described in four nodules of the thyroid gland. A CT scan was performed and a renal giant right tumor was found. The patient underwent an eventful radical right nephrectomy and the diagnosis of CCRC was confirmed. Discussion Thyroid metastasis (TM) from CCRC are usually apparent in a metachronic context during the follow-up of a treated primary (even many years after) but may sometimes be present at the same time than the primary renal tumor. Our case is exceptional because the TM was the first evidence of the CCRC, which was subsequently diagnosed and treated. Conclusion The possibility of finding of an incidental metastatic tumor in the thyroid gland from a previous unknown and non-diganosed primary (as CCRC in our case was) is rare and account only for less than 1% of malignancies. Nonetheless, the thyroid gland is a frequent site of metastasis and the presence of “de novo” thyroid nodules in oncologic patients must be always considered and studied.
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Affiliation(s)
- César Pablo Ramírez-Plaza
- General and Digestive Surgery Service, Hospital Quirón Málaga, Avenida Imperio Argentina, n°1, Málaga CP 29004, Spain.
| | - Marta Elena Domínguez-López
- Endocrinology Service, Hospital Regional Málaga Carlos Haya, Avenida Carlos Haya s/n, Málaga CP 29010, Spain
| | - Francisco Blanco-Reina
- Urology Service, Hospital Regional Málaga Carlos Haya, Avenida Carlos Haya s/n, Málaga CP 29010, Spain
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Beutner U, Leowardi C, Bork U, Lüthi C, Tarantino I, Pahernik S, Wente MN, Büchler MW, Schmied BM, Müller SA. Survival after renal cell carcinoma metastasis to the thyroid: single center experience and systematic review of the literature. Thyroid 2015; 25:314-24. [PMID: 25491306 DOI: 10.1089/thy.2014.0498] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Renal cell carcinoma can metastasize to uncommon sites, for example, the thyroid gland where metastases are rarely found. To determine the patient survival and the time between cancer diagnosis and thyroid metastasis, we analyzed a large patient cohort from our hospital records and performed a systematic review. PATIENTS AND METHODS Patients diagnosed between 1978 and 2007 with thyroid metastases from renal cell carcinoma were retrospectively identified from the hospital database. A systematic literature search was performed for publications describing at least three cases of thyroid metastasis from renal cell carcinoma. Case data from the identified studies were collected and used to determine the survival data. RESULTS We identified 34 patients (19 females) from our hospital records with a mean age of 67 years (range, 33-79) when thyroid metastasis was diagnosed. Median time to primary metastasis after resection of renal cell carcinoma was 6.5 years (range, 0-25) with a single case of synchronous metastasis. Median survival after primary metastasis was 4.7 years (95% confidence interval [CI]: 1.8-7.6). The systematic review included 32 studies with 285 patients. Case data could be extracted for 202 patients. Median time to thyroid metastasis (without synchronous cases) was 8.8 years (95% CI: 7.5-10.1). Median actuarial survival after thyroid metastasis was 3.4 years (95% CI: 2.2-4.6). Total thyroidectomy was not associated with a better survival compared to partial thyroidectomies. CONCLUSIONS Time to thyroid metastasis of renal cell carcinoma can be very long, and survival after thyroidectomy is favorable compared to metastasis to other sites.
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Affiliation(s)
- Ulrich Beutner
- 1 Department of Surgery, Kantonsspital St. Gallen , St. Gallen, Switzerland
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Sakorafas GH, Goutis G, Elvanidou A, Katseni KK, Thanos D, Mitsaka D, Zobolas V. Metachronous intrathyroid-only metastases from breast cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.14.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract: Thyroid-only metastases from other primary cancers are rare and associated with poor prognosis. Breast cancer typically metastasizes to lymph nodes, liver and lungs, while isolated metastases to the thyroid gland are exceptionally rare and often difficult to suspect and differentiate from thyroid cancer (and most frequently poorly differentiated thyroid cancer), even by using fine needle aspiration. A patient with a history of breast cancer (4 years ago) with thyroid-only metastases is presented. Diagnostic and therapeutic problems are discussed and the relevant literature is briefly reviewed. The novelty of this data is that intrathyroid-only metastases from breast cancer are extremely uncommon and indicate generalized disease, and preoperative diagnosis can be difficult, even by using ultrasound-guided fine needle aspiration.
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Affiliation(s)
- George H Sakorafas
- Second Department of Surgery, Saint Savvas Cancer Hospital, Athens, Greece
| | - George Goutis
- Second Department of Surgery, Saint Savvas Cancer Hospital, Athens, Greece
| | - Agapi Elvanidou
- Second Department of Surgery, Saint Savvas Cancer Hospital, Athens, Greece
| | | | - Dimitrios Thanos
- Second Department of Surgery, Saint Savvas Cancer Hospital, Athens, Greece
| | - Dimitra Mitsaka
- Second Department of Surgery, Saint Savvas Cancer Hospital, Athens, Greece
| | - Vassileios Zobolas
- Second Department of Surgery, Saint Savvas Cancer Hospital, Athens, Greece
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Sawicki P, Kaźmierczak W, Burduk P, Kaźmierczak H. Multiple metastases of renal clear cell carcinoma to the organs of the head. Contemp Oncol (Pozn) 2014; 18:448-51. [PMID: 25784846 PMCID: PMC4355657 DOI: 10.5114/wo.2014.47474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/05/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022] Open
Abstract
Metastases of renal clear cell carcinoma to the organs of the head are rare. Single cases show that they can appear either shortly after or many years after radical surgery. The diagnosis of this cancer is difficult because of its insidious course; therefore, it is often diagnosed too late. Late diagnosis is associated with a high risk of distant metastases and increased mortality. The paper presents a case of a patient whose kidney tumour was diagnosed during hospitalisation at the Department of Rheumatology. Further diagnosis and surgical treatment were performed in the Department of Urology, where a left-sided nephrectomy was carried out. After two years, the patient was hospitalised in the Department of Otolaryngology due to dysphagia. The patient was subjected to fine-needle biopsy, surgical biopsy, CT, and ultrasound. Metastases of renal clear cell carcinoma were diagnosed based on a histopathological examination and the results of imaging studies. Due to the extent of the tumour, diagnostics were extended to magnetic resonance imaging. The patient was qualified for tracheotomy, cytoreductive surgery, and chemoradiation. The patient was referred for further treatment at the Centre of Oncology in Bydgoszcz.
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Affiliation(s)
- Piotr Sawicki
- Department of Otolaryngology, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Wojciech Kaźmierczak
- Department of Otolaryngology, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Henryk Kaźmierczak
- Department of Otolaryngology, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
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Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398:347-75. [PMID: 23456424 DOI: 10.1007/s00423-013-1057-6] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. METHODS The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. RESULTS The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. CONCLUSION These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
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Villumsen AL, Mevik K, Fjøsne HE, Brekke MB, Haugen OA. Senmetastaser til glandula thyreoidea fra nyrekarsinom. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:2262-5. [DOI: 10.4045/tidsskr.12.0884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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13
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Socrier Y, D'Aure D, Lacoste-Collin L, Escourrou G, Soule-Tholy M, Delisle MB, Courtade-Saïdi M. Cytology of a thyroid metastasis from an endometrial sarcoma: a case report. Cytopathology 2012; 24:408-9. [PMID: 22775569 DOI: 10.1111/j.1365-2303.2012.00994.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y Socrier
- Service d'Anatomie Pathologique et Histologie-CytologieService de Chirurgie Générale et Gynécologique, Hôpital de Rangueil, Toulouse Cedex, France
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14
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Bex A. Metastasectomy. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Baïzri H, Bordier L, Garcia C, Gaëtan G, De Kérangal X, Durand X, Dupuy O, Bauduceau B, Mayaudon H. [Thyroid metastasis of kidney cancer]. Rev Med Interne 2010; 32:e37-9. [PMID: 20591540 DOI: 10.1016/j.revmed.2010.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 03/30/2010] [Accepted: 04/11/2010] [Indexed: 11/18/2022]
Abstract
Thyroid metastasis of solid tumors is rare and often asymptomatic. Differential diagnosis with malignant thyroid tumor is difficult. We report a 65-year-old man who presented with a solitary intrathoracic thyroid nodule of the left lobe, inaccessible to fine needle biopsy. His past medical history was remarkable for a nephrectomy for a kidney clear cell carcinoma one year before. The PET-scan did not show any abnormal fixation. A left lobo-isthmectomy was performed. Histologic examination revealed an intrathyroid metastasis of kidney carcinoma.
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Affiliation(s)
- H Baïzri
- Service d'endocrinologie, hôpital d'Instruction des Armées Bégin, 69 avenue de Paris, Saint-Mandé, France.
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Rizzo M, Rossi RT, Bonaffini O, Scisca C, Sindoni A, Altavilla G, Benvenga S. Thyroid metastasis of clear cell renal carcinoma: Report of a case. Diagn Cytopathol 2009; 37:759-62. [PMID: 19530097 DOI: 10.1002/dc.21117] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Renal cell carcinoma can recur many years after diagnosis and nephrectomy metastasizing even in uncommon sites, including thyroid gland. Thyroid metastases are extremely rare, the most frequent site of origin are renal tumors. Metastases in thyroid gland appear as painless nodules or masses, "cold" at scintiscan. We report the case of a 67-year-old male patient affected by clear cell renal carcinoma, diagnosed by fine-needle aspiration cytology procedures, and treated with anticancer medical therapy, who noticed after some months a mass in the neck-thyroid region requiring deeper medical investigations. By this way, thyroid fine-needle aspiration cytology reported a lesion made of malignant epithelial cells compatible with metastases of renal carcinoma (clear cell). Clinical and pathological data, together with immunostaining, supported the diagnosis of metastatic clear cell renal carcinoma. The diagnosis of metastatic disease, although difficult clinically and pathologically, should be suspected in patients with a clinical history of cancer, particularly in case of renal cell carcinoma, but fine-needle aspiration cytology can provide the clue for diagnosis.
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Affiliation(s)
- Massimo Rizzo
- Department of Human Pathology, Laboratory of Diagnostic Cytology, Section of Medical Oncology, University of Messina, Messina, Italy.
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Abstract
Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines' actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis. Hypothyroidism is accompanied by a decrease in glomerular filtration, hyponatremia, and an alteration of the ability for water excretion. Excessive levels of TH generate an increase in glomerular filtration rate and renal plasma flow. Renal disease, in turn, leads to significant changes in thyroid function. The association of different types of glomerulopathies with both hyper- and hypofunction of the thyroid has been reported. Less frequently, tubulointerstitial disease has been associated with functional thyroid disorders. Nephrotic syndrome is accompanied by changes in the concentrations of TH due primarily to loss of protein in the urine. Acute kidney injury and chronic kidney disease are accompanied by notable effects on the hypothalamus-pituitary-thyroid axis. The secretion of pituitary thyrotropin (TSH) is impaired in uremia. Contrary to other non-thyroidal chronic disease, in uraemic patients it is not unusual to observe the sick euthyroid syndrome with low serum triodothyronine (T(3)) without elevation of reverse T(3) (rT(3)). Some authors have reported associations between thyroid cancer and kidney tumors and each of these organs can develop metastases into the other. Finally, data from recent research suggest that TH, especially T(3), can be considered as a marker for survival in patients with kidney disease.
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Affiliation(s)
- P Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Carretera de Colmenar, Madrid, Spain.
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Rodier JF, Tuech JJ, Wilt M, Lindas P, Bruant-Rodier C. [A locally advanced intrathyroid metastasis of bronchial cancer]. ACTA ACUST UNITED AC 2008; 125:198-203. [PMID: 18755448 DOI: 10.1016/j.aorl.2008.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 07/03/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the characteristics, the diagnosis and the treatment of intrathyroid metastasis. METHOD The authors report a case of a locally advanced intrathyroid metastasis of a bronchial cancer. RESULTS A 60-year-old woman, treated seven years before for a well-differentiated bronchial adenocarcinoma, developed enlargement of the thyroid gland. Metastatic disease was confirmed by a surgical biopsy. Following incomplete radiochemotherapy, a palliative surgical debulking was performed, associating an isthmolobectomy with a large skin excision and closure with a pectoralis major myocutaneous flap. CONCLUSION Intrathyroid metastases are rare and usually treated by surgery. Surgical management is decided taking into account the type and the kinetics of the primary tumor, the location of the thyroid metastasis, and the extension of the metastatic disease. Except for isolated intrathyroid metastasis of kidney cancer, prognosis remains poor.
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Affiliation(s)
- J-F Rodier
- Département de chirurgie-oncologique, centre de lutte contre le cancer Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France.
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JANKOWSKA P, TEOH EM, FISHER C, RHYS EVANS P, NUTTING CM, HARRINGTON KJ. Isolated intrathyroid metastasis from undifferentiated and squamous carcinoma of the head and neck: the case for surgery and re-irradiation. Br J Radiol 2008; 81:e154-61. [DOI: 10.1259/bjr/26919796] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Iesalnieks I, Winter H, Bareck E, Sotiropoulos GC, Goretzki PE, Klinkhammer-Schalke M, Bröckner S, Trupka A, Anthuber M, Rupprecht H, Raab M, Meyer W, Reichmann F, Kästel M, Mayr M, Braun W, Schlitt HJ, Agha A. Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. Assessment of factors affecting patients' survival. Thyroid 2008; 18:615-24. [PMID: 18578610 DOI: 10.1089/thy.2007.0343] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Metastases of renal cell carcinoma (RCC) to the thyroid gland are uncommon. There is no clear consensus regarding the role of surgery in metastatic disease to the thyroid since most clinical studies include small numbers of patients. Also, risk factors associated with disease progression following thyroidectomy are not yet defined. We examined the determinants of the outcome in patients undergoing surgery for thyroid metastases of RCC. METHODS The medical records of 45 patients undergoing resection of thyroid metastases of RCC at 15 institutions in Germany and Austria were reviewed retrospectively. The outcome parameters assessed were overall survival and tumor-related survival. Factors associated with disease progression following thyroid surgery have been calculated. RESULTS The overall 5-year survival rate following thyroid metastasectomy was 51%. Nineteen patients died during the study: 14 of disseminated disease and 5 of non-tumor-related causes. In the multivariate analysis, the prognosis was significantly worse in patients older than > or = 70 years and in patients who had undergone nephrectomy for metastases in the contralateral kidney during the course of the disease. Nine patients developed a thyroid recurrence following surgery. No local disease relapse occurred if resection margins were documented to be free of the tumor. Of the 45 patients with thyroid metastases, 14 (31%) developed pancreatic metastases during the course of disease. Ten of these patients also underwent pancreatic surgery with a 5-year survival rate of 43% in this subgroup. CONCLUSIONS The overall survival of patients undergoing thyroidectomy for metastases of RCC is affected rather by general health status than by tumor-related factors. There is a significant coincidence of thyroid and pancreatic metastases of RCC.
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Affiliation(s)
- Igors Iesalnieks
- Department of Surgery, University of Regensburg, Regensburg, Germany.
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Abstract
Renal carcinoma, the third most common urological cancer, induces presence of metastases in 75% of cases. The most affected sites for metastasis are the lungs, the lymphatic system, bones, the liver, adrenal glands and the brain with sometimes a cancer free period of several years prior to evolutionary recurrence of the disease. The aim of this literature review is to report on secondary uncommon renal localizations by underlining their clinical significance, as well as main characteristics, in order to provide guidelines for effective patient diagnosis and therapeutic management.
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Affiliation(s)
- A Vidart
- Service d'urologie, CHU Rouen, 1, rue de Germont, 76031 Rouen, France
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Bugalho MJM, Mendonça E, Costa P, Rosa Santos J, Silva E, Catarino AL, Sobrinho LG. A multinodular goiter as the initial presentation of a renal cell carcinoma harbouring a novel VHL mutation. BMC Endocr Disord 2006; 6:6. [PMID: 17067398 PMCID: PMC1634746 DOI: 10.1186/1472-6823-6-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/26/2006] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Secondary involvement of the thyroid gland is rare. Often the origin of the tumor is difficult to identify from the material obtained by fine-needle aspiration cytology. Renal cell carcinoma of the clear-cell type is one of the more common carcinomas to metastasize to the thyroid gland. Somatic mutations of the von Hippel-Lindau tumor suppressor gene are associated with the sporadic form of this tumor. We aimed to illustrate the potential utility of DNA based technologies to search for specific molecular markers in order to establish the anatomic site of origin. CASE PRESENTATION A 54-yr-old Caucasian male complaining of a rapidly increasing neck tumor was diagnosed as having a clear-cell tumor by fine-needle aspiration cytology. A positive staining for cytokeratin as well as for vimentin and CD10 in the absence of staining for thyroglobulin, calcitonin and TTF1 suggested a renal origin confirmed by computed tomography. Using frozen RNA, obtained from cells left inside the needle used for fine needle aspiration cytology, it was possible to identify a somatic mutation (680 delA) in the VHL gene. CONCLUSION In the presence of a clear-cell tumor of the thyroid gland, screening for somatic mutations in the VHL gene in material derived from thyroid aspirates might provide additional information to immunocytochemical studies and therefore plays a contributory role to establish the final diagnosis. Moreover, in a near future, this piece of information might be useful to define a targeted therapy.
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Affiliation(s)
- Maria João M Bugalho
- Serviço de Endocrinologia, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
- Centro de Investigação de Patobiologia Molecular, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Evelina Mendonça
- Serviço de Anatomia Patológica, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Patrícia Costa
- Centro de Investigação de Patobiologia Molecular, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Jorge Rosa Santos
- Serviço de Cirurgia de Cabeça e Pescoço, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Eduardo Silva
- Serviço de Urologia, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Ana Luísa Catarino
- Serviço de Anatomia Patológica, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Luís G Sobrinho
- Serviço de Endocrinologia, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
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Mirallié E, Rigaud J, Mathonnet M, Gibelin H, Regenet N, Hamy A, Bretagnol F, de Calan L, Le Néel JC, Kraimps JL. Management and prognosis of metastases to the thyroid gland. J Am Coll Surg 2005; 200:203-7. [PMID: 15664095 DOI: 10.1016/j.jamcollsurg.2004.10.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 10/04/2004] [Accepted: 10/04/2004] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intrathyroid metastases (ITM) of extrathyroid cancer are rare and have a poor prognosis. The aim of this work was to identify the sites of primary cancers and the treatment and prognosis of these lesions. STUDY DESIGN This retrospective study was carried out on patients treated between 1982 and 2002 in the surgical departments of the University hospitals of Poitiers, Limoges, Tours, and Nantes, France. All diagnoses were confirmed by cytology or histologic examination. RESULTS Twenty-nine patients (41 to 78 years) had ITM. Primary cancers were renal cell in 16 patients, lung in 4, digestive in 4, sarcoma in 1, melanoma in 1, neuroendocrine in 1, and of unknown origin in 1 patient. For 10 patients, diagnoses of primary cancer and ITM were synchronous. For 19 patients, delay between diagnosis of the primary cancer and ITM was 6.8 years (2 months to 16 years). Diagnosis was confirmed with fine-needle aspiration 3 times and with histologic examination of the thyroid 26 times. Twenty-seven patients had thyroidectomy; two were not operated on. After treatment of ITM, 13 patients had new metastatic sites. Mean followup for all patients was 2.3 years. Seven patients (24%) (6 with renal cancer) were disease free (followup 4.5 years). Four patients were alive with disease (followup 1.4 years). Eighteen patients (62%) died of their disease at a mean delay of 1.4 years. CONCLUSIONS ITM are rare but the diagnosis should be borne in mind when patients have a history of cancer (mainly renal cancer). Preoperative diagnosis and complete evaluation could avoid unnecessary thyroidectomy because numerous patients had diffuse metastases.
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Affiliation(s)
- Eric Mirallié
- Department of Surgery, Clinique Chirurgicale A, Hôtel Dieu, University Hospital Nantes, 44093 Nantes, France
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