Metastasis of squamous cell carcinoma of the head and neck to the thyroid: a single institution's experience with a review of relevant publications

Metastatic oropharyngeal squamous cell carcinoma to the thyroid: A case report and review of literature

Oral squamous cell carcinoma (OSCC) with metastasis to the thyroid gland is exceedingly rare, with limited documentation within the literature. Between 1984 and 2023, only 40 cases of head and neck squamous cell carcinoma (SCC) with thyroid gland metastasis were described in published literature. Herein, we present a distinctive case of second primary oropharyngeal SCC with metastasis to the thyroid, detected during surveillance positron emission tomography (PET) scanning subsequent to negative margin resection and radiation therapy for SCC originating from the hard palate. The underlying mechanisms overseeing metastasis remain elusive, with hypotheses ranging from lymphatic drainage routes connecting the thyroid gland and retropharyngeal lymph nodes to hematologic dissemination. The management of metastases to the thyroid gland is multifaceted, encompassing approaches ranging from lobectomy and total thyroidectomy to palliative interventions. We present this atypical case alongside supportive pathological and radiological findings and a comprehensive review of this rare clinical entity to offer insight into its diagnosis and management.

Cervical lymph node metastasis as the first symptom of combined anaplastic thyroid carcinoma (squamous cell carcinoma) and follicular carcinoma: a case report

BACKGROUND

Anaplastic thyroid carcinoma(ATC) is a rare pathological type of thyroid malignancy. Primary squamous cell carcinoma of thyroid(PSCCT) is now considered as a subtype of ATC, hereinafter referred to as ATC-SCC subtype. ATC-SCC subtype combined with follicular thyroid carcinoma is exceedingly rare, with fewer cases reported. The ATC-SCC subtype is a highly invasive tumor with a poor prognosis for patients after metastasis occurs, and current treatment of this type of tumor is tricky.

CASE PRESENTATION

A 68-year-old female patient presented with a gradually growing swelling of right cervical region. Comprehensive auxiliary examinations and postoperative pathology confirmed the diagnosis of ATC-SCC subtype with follicular thyroid carcinoma, and the metastasis squamous cell carcinoma of the right cervical lymph nodes originates from ATC-SCC subtype. The patient received chemoradiotherapy postoperative. However, the residual cervical lymph nodes metastasis with squamous cell carcinoma still infiltrated surrounding structures in the neck extensively after palliative resection. The patient died 7 months after surgery.

CONCLUSION

Our case highlights that cervical lymph node metastasis may be a significant factor in the poor prognosis of ATC-SCC subtype. This malignancy should be detected and treated early.

To diagnose primary and secondary squamous cell carcinoma of the thyroid with ultrasound malignancy risk stratification

Objectives

This study aimed to investigate the clinico-ultrasound features of primary squamous cell carcinoma of the thyroid (PSCCT) and secondary SCCT (SSCCT) and evaluate the accuracy of fine needle aspiration (FNA) recommendation for SCCT with American College of Radiology-Thyroid Imaging and Reporting Data System (ACR-TIRADS) and Chinese-TIRADS (C-TIRADS).

Materials and methods

We retrieved 26 SCCT patients (11 PSCCT, 15 SSCCT) from our hospital's pathology database (5,718 patients with thyroid malignancy) over 23 years. Medical records and ultrasound data of the 26 patients with 27 SCCTs were analyzed retrospectively, and each SCCT focus was categorized based on the two TIRADSs.

Results

For 26 patients (21 males, 5 females) with an age range of 42-81 years, rapidly enlarging thyroid/neck nodules (18/26, 69.2%), dysphagia (7/26, 26.9%), hoarseness (6/26, 23.1%), dyspnea (5/26, 19.6%), cough (4/26, 15.4%), neck pain (2/26, 7.7%), B symptoms (2/26, 7.7%), and blood in sputum (1/26, 3.8%) were presented at diagnosis. Five asymptomatic patients (5/26, 19.2%) were detected by ultrasound. Hoarseness was more common in PSCCT (5/11, 45.5%) than in SSCCT (1/15, 6.7%) (P=0.032). For 27 SCCTs with a mean size of 3.7 ± 1.3 cm, the ultrasound features consisted of solid (25/27, 92.6%) or almost completely solid composition (2/27, 7.4%), hypoechoic (17/27, 63%) and very hypoechoic echogenicity (10/27, 37%), irregular/lobulated margin with extra-thyroidal extension (27/27, 100%), taller-than-wide shape (13/27, 48.1%), punctate echogenic foci (6/27, 22.2%), hypervascularity (23/27, 85.2%) and involved neck lymph (13/26, 50.0%). A total of 27 SCCTs were evaluated as high malignancy risk stratification (≥TR4 and 4B) by the two TIRADSs and recommended FNA in 96.3-100% (26/27, 27/27). Pathologically, more than half of PSCCTs (7/12, 58.3%) and a quarter of SSCCTs (4/15, 26.7%) were poorly differentiated, while moderately and well-differentiated grades were observed in 5 PSCCTs and 11 SSCCTs (P=0.007). Thirteen patients (50.0%) underwent surgery with radical operation in 5 cases (5/13, 38.5%).

Conclusion

SCCT is an extremely rare and aggressive malignancy with a male predominance. PSCCT and SSCCT had similar clinical and ultrasound features except for tumor differentiation and the symptom of hoarseness. SCCT showed a high malignancy risk stratification in ACR-TIRADS and C-TIRADS, with a high rate of FNA recommendation.

Ultrasonic Characterization of Primary Squamous Cell Carcinoma of the Thyroid

OBJECTIVES

To identify the ultrasonographic characteristics of primary squamous cell carcinoma of the thyroid (PSCCT), and to assess the value of the 2015 American Thyroid Association (ATA) guideline and 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) in the evaluation of this disease.

METHODS

Eight patients with 9 PSCCTs over a 20-year study period were enrolled. Ultrasonic characteristics including nodule echogenicity, composition, shape, margin, calcification, size, vascularity, and cervical lymphadenopathy were reviewed. All nodules were then evaluated by 2017 ACR TI-RADS and 2015 ATA guidelines.

RESULTS

The average size of PSCCTs was 3.87 ± 1.41 cm. All PSCCTs were hypoechoic or very hypoechoic, solid nodules with intranodular vascularity. The average resistive index (RI) was 0.84 ± 0.18. Near half of PSCCTs (44.4%) demonstrated extrathyroidal extension. Taller-than-wide signs and cervical lymphadenopathy were observed in 33.3% of PSCCTs, and microcalcification was observed in 11.1% of them. All PSCCTs were classified as high suspicion patterns by 2015 ATA and recommended for fine-needle aspiration (FNA). Six PSCCTs (66.7%) were classified as grade 5 by 2017 ACR TI-RADS, while the remaining were grade 4. 88.9% of PSCCTs were recommended for FNA based on 2017 ACR TI-RADS.

CONCLUSION

PSCCT has certain ultrasonic features, including relatively large, hypoechoic, or very hypoechoic solid nodules with intranodular vascularity and extrathyroidal extension. Both 2015 ATA and 2017 ACR TI-RADS could identify PSCCT as suspicious for malignancy.

Fine-needle aspiration cytology of an intrathyroidal nodule diagnosed as squamous cell carcinoma: A case report

BACKGROUND

Both squamous cell carcinoma (SCC) and papillary thyroid carcinoma (PTC) are common malignant tumors in the neck. However, seldom has SCC of the thyroid been diagnosed. Further, cytological features of SCC and PTC have rarely been reported. The significance of fine-needle aspiration cytology (FNAC) in the diagnosis of neck masses has been established. Herein, we present an exceedingly rare case of an intrathyroidal SCC diagnosed using FNAC, along with its cytological features.

CASE SUMMARY

A 66-year-old man presented with a left-sided neck mass. Ultrasound examination showed an ill-defined nodule. The appearance was hypoechoic with a few hyperechoic spots. FNAC of the left thyroid nodule was performed. A cellular smear was obtained, and it showed a large number of neoplastic cells with rich cytoplasm and poor cell adhesion. Tumor cell nuclei showed coarse nuclear chromatin and a few enlarged prominent nucleoli. An increased nuclear/cytoplasm ratio was observed. Thus, malignancy was diagnosed without a confirmed tumor type. Percutaneous tumor biopsy was performed to make a definite diagnosis. The tumor cells showed typical squamous cell characteristics.

CONCLUSION

Head and neck SCC and PTC have different cytologies. Measures are needed to ensure accurate diagnosis using FNAC.

Oncogenic circDHTKD1 promotes tumor growth and metastasis of oral squamous cell carcinoma in vitro and in vivo via upregulating miR-326-mediated GAB1

Circular RNAs (circRNAs) have been extensively elucidated with regard to their significant implications in oral squamous cell carcinoma (OSCC). This study performed the functional investigation of circRNA dehydrogenase E1 and transketolase domain containing 1 (circDHTKD1) in OSCC. RNA expression levels of different molecules were measured via quantitative real-time polymerase chain reaction (qRT-PCR). Cellular behaviors were detected by 3-(4, 5-dimethylthiazol-2-y1)-2,5-diphenyl tetrazolium bromide (MTT) for cell viability, colony formation assay for clonal capacity, flow cytometry for cell apoptosis, wound healing assay for migration, and transwell assay for migration/invasion. Western blot was used for analyzing protein expression. RNA pull-down and dual-luciferase reporter assays were applied to assess the binding between targets. A xenograft tumor model was established in nude mice for in vivo experiments. Our expression analysis revealed that circDHTKD1 was upregulated in OSCC tissues and cells. circDHTKD1 knockdown was shown to impede OSCC cell growth and metastasis but motivate apoptosis. Additionally, circDHTKD1 served as a microRNA-326 (miR-326) sponge and the function of circDHTKD1 was achieved by sponging miR-326 in OSCC cells. Also, miR-326 inhibited OSCC development via targeting GRB2-associated-binding protein 1 (GAB1). circDHTKD1 could sponge miR-326 to alter GAB1 expression. Furthermore, circDHTKD1 contributed to OSCC progression in vivo via the miR-326/GAB1 axis. These data disclosed a specific circDHTKD1/miR-326/GAB1 signal axis in governing the malignant progression of OSCC, showing the considerable possibility of circDHTKD1 as a predictive and therapeutic target for clinical diagnosis and treatment of OSCC.

Primary squamous cell carcinoma of the thyroid: a case report

Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare and rapidly progressive malignancy that carries a poor prognosis. PSCCT is easily misdiagnosed as acute thyroiditis or as another thyroid malignancy. We have reported a 76-year-old woman who presented with progressive neck pain for 1 month. Thyroid function tests revealed subclinical thyrotoxicosis. Ultrasound disclosed a solid nodule with calcification in the right thyroid lobe. Laboratory findings included neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate. The patient's condition was diagnosed as subacute thyroiditis, and she was treated with cefixime and ibuprofen. However, her treatment response was poor. She was then treated with oral prednisone. Her neck pain gradually resolved. The patient subsequently developed dysphagia, choking, dyspnea, and dysphonia with an insidious onset. Further examinations including computed tomography and painless gastroscopy revealed that the volume of the thyroid gland had increased significantly, extending to the anterior superior mediastinum. The trachea and esophagus were stenotic because of external compression. Partial thyroidectomy and tracheotomy were performed under extracorporeal membrane oxygenation. The diagnosis of PSCCT was established via histopathology and immunohistochemistry.

Analysis of primary and secondary squamous cell carcinoma of the thyroid gland: a retrospective study

Background

Squamous cell carcinoma of the thyroid (SCCT) is a kind of rare malignant disease. This study aimed to analyse the clinical characteristics of patients with primary SCCT (PSCCT) and secondary SCCT (SSCCT).

Methods

The medical records of seventeen patients with PSCCT and six patients with SSCCT were reviewed. Clinical symptoms, ultrasound, and pathological characteristics were compared between the two groups.

Results

The mean age of diagnosis was approximately 56 years old in each group. The most common chief complaint of the patients was neck mass in both groups. The percentage of patients with cough (P=0.008) or weight loss (P=0.021) was higher in the SSCCT group than the PSCCT group. The mean size of the tumor in the PSCCT group was larger than that in the SSCCT group (3.382±2.011 vs. 1.950±0.794 cm, P=0.024). Papillary thyroid carcinoma (PTC) could be combined with or recur as PSCCT. Kaplan-Meier analysis indicated that the mean survival times after diagnosis were 17.053 months in the PSCCT patients and 13.500 months in the SSCCT patients. Multivariate survival analysis using a Cox regression model demonstrated that predictors of overall survival (OS) in PSCCT patients included age (P=0.020), enlarged cervical lymph node (P=0.017), radical operation (P=4.82×10^-3), and PTC (P=0.03).

Conclusions

SCCT is aggressive, with neck mass being the most common chief complaint. There were several different characteristics between PSCCT and SSCCT. PTC could be combined with or recur as PSCCT. Age, enlarged cervical lymph node, radical operation, and PTC were the predictors of OS in PSCCT patients.

Metastases to the thyroid gland: review of incidence, clinical presentation, diagnostic problems and surgery, our experience

PURPOSE

Metastases to the thyroid gland are uncommon and they represent 1-3% of all thyroid malignancy. The aim of this study is to analyze the diagnostic problems and the role of surgery in metastatic lesions to the thyroid.

METHODS

We retrospectively analyzed all patients who had undergone thyroidectomy at our Center. Out of more than 5000 thyroidectomies performed, only 9 cases had metastases to the thyroid gland.

RESULTS

The most common primary tumor arises from kidney and lung. Non-thyroid malignancies diagnosis was obtained with US, FNAC and PET-CT. Surgery was performed in all our series (except for one case) and the expectancy of life after surgery is related to the primary tumor and comorbidities of patients.

CONCLUSION

The thyroid gland can be a rare site of metastases for many tumors, especially in an abnormal thyroid gland. Surgery is associated with an improved survival and the extension of surgery depends on the extension of the neoplastic lesion.

Circ-PVT1/miR-106a-5p/HK2 axis regulates cell growth, metastasis and glycolytic metabolism of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most commonly diagnosed oral cavity malignancy. A handful of circular RNAs (circRNAs) have recently shown to act as crucial regulators in OSCC, including circRNA plasmacytoma variant translocation 1 (circ-PVT1). However, further exploration is still needed for the underlying functional mechanism behind circ-PVT1 in OSCC. The levels of circ-PVT1, microRNA-106a-5p (miR-106a-5p) and hexokinase II (HK2) were all examined applying with quantitative real-time polymerase chain reaction (qRT-PCR). Cellular analyses (cell viability, apoptosis, metastasis and glycolysis) in vitro were performed via cell counting kit-8 (CCK-8), flow cytometry, transwell migration/invasion assays and glycolysis-related indications (glucose consumption, lactate production and ATP/ADP ratio). HK2 protein level was measured through western blot. Dual-luciferase reporter assay was conducted to study the interplay between miR-106a-5p and circ-PVT1 or HK2. Xenografts in mice were used for analyzing circ-PVT1 in vivo. Circ-PVT1 was expressed with abnormal high level while miR-106a-5p was down-regulated in OSCC tissues and cells. Circ-PVT1 knockdown reduced OSCC cell growth, metastasis and glycolysis. Moreover, circ-PVT1 acted in OSCC by functioning as a miR-106a-5p sponge. HK2 was a target of miR-106a-5p and miR-106a-5p played an anti-tumor role in OSCC by inhibiting HK2. Furthermore, HK2 could be regulated by circ-PVT1 via targeting miR-106a-5p. In xenograft models of mice, down-regulation of circ-PVT1 retarded tumorigenesis via the miR-106a-5p/HK2 axis. Our works suggested that circ-PVT1 directly combined with miR-106a-5p to mediate HK2 level, consequently regulating cellular behaviors in OSCC as a tumor promoter.

Prevalencia de tumores metastásicos en la glándula tiroides. Revisión sistemática y metanálisis

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).