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Rojesara M, Sattavan S, Sharma M, Rathod P, Puj K, Pandya S, Bande V, Pawar A, Ghosh N, Bhat S S, Kumar M S. Wide Composite Resection of Sternal Metastasis & Reconstruction Using Titanium Mesh Implant and Myocutaneous Flap in Differentiated Thyroid Carcinoma: Case Report of Two Cases. Indian J Otolaryngol Head Neck Surg 2024; 76:1347-1350. [PMID: 38440601 PMCID: PMC10908690 DOI: 10.1007/s12070-023-04326-8] [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: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 03/06/2024] Open
Abstract
Differentiated Thyroid carcinoma (DTC) with distant skeletal metastases is associated with a very poor prognosis and are unfortunately resistant to radioiodine therapy (RIT). Surgical removal of the metastases in such selected cases is a beneficial adjunct to RIT. We report two cases of DTC with sternal metastases whom we successfully managed with surgical resection of the sternal lesion with reconstruction of the chest wall defect using titanium mesh implant and myocutaneous flap.
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Affiliation(s)
- Mit Rojesara
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Swati Sattavan
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Mohit Sharma
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Priyank Rathod
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ketul Puj
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Vivek Bande
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ajinkya Pawar
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Nilanjan Ghosh
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Sankhya Bhat S
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Senthil Kumar M
- Department of Surgical Oncology, Gujrat Cancer and Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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Al Hassan MS, El Ansari W, Wali HS, Massad E, Darweesh A, Abdelaal A. Bilateral follicular thyroid carcinoma with large sternal metastasis: Case report and review of the literature. Int J Surg Case Rep 2023; 112:108973. [PMID: 37913668 PMCID: PMC10667890 DOI: 10.1016/j.ijscr.2023.108973] [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: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Follicular thyroid cancer (FTC) typically spreads hematogenously, with bone metastasis being worrisome, often appearing to be resistant to radioactive iodine (RAI) therapy. Metastasis to sternum is exceedingly rare. CASE PRESENTATION A 43-year-old Egyptian male presented with chest tightness, cough, and shortness of breath. He was initially treated as bronchial asthma. Later, he was referred to our thyroid surgery clinic as a case of goitre and palpable sternal mass. He looked clinically well, with enlarged anterior neck mass and visible sternal mass, no lymphadenopathy. Laboratory tests showed thyroid-stimulating hormone levels within normal (2.13 mIU/L), and mildly decreased FT4 (10.3 pmol/L). Neck/chest CT demonstrated multinodular goitre with retrosternal extension, expansile lytic lesion in the sternum, and bilateral lung metastases. Thyroid fine needle aspiration and cytology showed FLUS, and true cut biopsy from the sternal lesion showed invasive FTC. DISCUSSION Rare bilateral FTC presenting as slow-growing sternal metastasis. The patient underwent total thyroidectomy, followed by high dose RAI therapy, and concluded with sternectomy and reconstruction surgery repair using polymethyl methacrylate wrapped in proline mesh. On follow-up, he received further RAI ablation therapy and became RAI refractory. He then received systemic therapy (Lenvatinib). Most recent follow up showed that the disease was controlled (low volume cancer) and he was tolerating treatment well with no reported symptoms. CONCLUSION Bilateral FTC with sternal metastasis is rare, and can be treated with total thyroidectomy, sternectomy and reconstruction, followed by RAI therapy and systemic therapy where required, hence inferring real survival benefit.
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Affiliation(s)
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Hamza Said Wali
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar.
| | - Ehab Massad
- Department of Thoracic Surgery, Hamad General Hospital, Doha, Qatar.
| | - Adham Darweesh
- Department of Clinical Imaging, Hamad General Hospital, Doha, Qatar
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Gokoglu A, Orunoglu M, Eksi MS, Arsa V, Selcuklu A. Dural and calvarial metastasis of thyroid follicular carcinoma mimicking Sindou type 6 parafalcine meningioma. J Cancer Res Ther 2023; 19:2098-2100. [PMID: 38376330 DOI: 10.4103/jcrt.jcrt_2017_21] [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: 11/08/2021] [Accepted: 01/03/2022] [Indexed: 02/21/2024]
Abstract
ABSTRACT Fifty-two years, NID type-2 diabetic female was admitted with progressive headache, enlarging, pulsatile midline mass, dizziness, and numbness of extremities. Physical examination revealed only hypoesthesia in the upper left extremity C7-dermatome. Preoperative computed tomography revealed eroded parafalcian dural mass and caused a round 7 cm calvarial defect over the superior sagittal sinus (SSS) and another left parietal 1.2 cm satellite mass. Magnetic resonance imaging revealed an extra-axial, diffuse heterogeneous gadolinium-enhanced, well-circumscribed lesion invading the SSS and Trolard veins (bilaterally). Supratotal resection 1 cm from the tumor borders was performed, histopathology suggested papillary thyroid carcinoma follicular variant. The euthyroid patient underwent total thyroidectomy, and final pathology revealed invasive TFC. 5-year follow-up was uneventful without recurrence or new metastasis. Parafalcian meningioma classification was reviewed for the best surgical approach. The definitive diagnosis of meningioma should be established with histopathological analysis. TFC should be included in the differential diagnosis in cases of extra-axial tumors.
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Affiliation(s)
| | - Merdan Orunoglu
- Department of Neurosurgery, Kayseri Community Hospital, Kayseri, Turkey
| | - Murat Sakir Eksi
- Department of Neurosurgery, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Vedat Arsa
- Department of Pathology, Health Sciences University, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Ahmet Selcuklu
- Department of Neurosurgery, Erciyes University, Kayseri, Turkey
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Batta R, Njoum Y, Deek R, Awad F, Bakri IA, Maree M. Follicular thyroid carcinoma with sternal metastasis: A case report. Int J Surg Case Rep 2023; 109:108625. [PMID: 37566985 PMCID: PMC10425392 DOI: 10.1016/j.ijscr.2023.108625] [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: 07/09/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sternal metastasis of follicular thyroid cancer (FTC) is rare as only 15 cases have been reported in the literature in which most cases of sternal metastasis occurs form breast and lung cancer. Surgical excision of the metastatic mass provides the best option due to its curative benefit, symptomatic palliation, and better response to radioactive iodine. CASE PRESENTATION Herein, we present a 77-year-old female patient with a known history of follicular thyroid carcinoma with isolated sternal metastasis treated with total thyroidectomy and en-bloc resection of the metastasis, followed by chest wall reconstruction using pectoralis major muscle flap. CLINICAL DISCUSSION Surgical excision of metastatic FTC to sternum with chest wall reconstruction was seldom reported as the treatment of choice. In most cases in the literature, mesh was used. However, in our patient mesh was not used taking into consideration the drastic consequences of wound infection and the possible need for mesh retrieval in such a dangerous area in proximity to the mediastinum. We believe that myo-adipo-facial flap is a more reasonable and safe option. CONCLUSION In patients with FTC, large tumors and bone metastases are factors that indicate poor prognostic factors, both of which were present in our patient. However, surgical excision provides hope for a better quality of life as it enhances subsequent Radioactive Iodine (RAI) therapy.
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Affiliation(s)
- Rita Batta
- General surgery department, Al-Makassed Hospital, Jerusalem, Palestine.
| | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Rahmeh Deek
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Fadi Awad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Izzeddin A Bakri
- Pathology department, Al-Makassed Hospital, Jerusalem, Palestine
| | - Mohammed Maree
- General surgery department, Al-Makassed Hospital, Jerusalem, Palestine
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Heidinger M, Simonnet E, Koh LM, Frey Tirri B, Vetter M. Therapeutic approaches in patients with bone metastasis due to endometrial carcinoma - A systematic review. J Bone Oncol 2023; 41:100485. [PMID: 37250286 PMCID: PMC10213377 DOI: 10.1016/j.jbo.2023.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Bone metastases (BM) are uncommon in endometrial carcinoma (EC), without information on the optimal oncologic management of patients with BM in EC. Here, we systematically review clinical characteristics, treatment approaches and prognosis in patients with BM in EC. Methods We conducted a systematic literature search until 27th March 2022 on PubMed, MEDLINE, Embase and clinicaltrials.gov. Outcomes included treatment frequency and survival after BM with comparators being treatment approaches (local cytoreductive bone surgery, systemic therapy, and local radiotherapy). Risk of bias was assessed using the NIH Quality Assessment Tool and Navigation Guide methodology. Results We retrieved 1096 records of which 112 retrospective studies (12 cohort studies, 12/12 fair quality; 100 case studies, 100/100 low quality) with a total of 1566 patients were included. The majority had a primary diagnosis of FIGO stage IV, grade 3 endometrioid EC. Singular BM were present in a median of 39.2%, multiple BM in 60.8% and synchronous additional distant metastases in 48.1% of patients respectively. In patients with secondary BM median time to bone recurrence was 14 months. Median survival after BM was 12 months. Local cytoreductive bone surgery was assessed in 7/13 cohorts and performed in a median of 15.8% (interquartile range [IQR] 10.3-43.0) of patients. Chemotherapy was assessed in 11/13 cohorts and administered in a median of 55.5% (IQR 41.0-63.9), hormonal therapy (7/13 cohorts) in 24.7% (IQR 16.3-36.0), and osteooncologic therapy (4/13 cohorts) in 2.7% (IQR 0.0-7.5) of patients respectively. Local radiotherapy was assessed in 9/13 cohorts and performed in a median of 66.7% (IQR 55.6-70.0) of patients. Survival benefits were seen in 2/3 cohorts after local cytoreductive bone surgery, and in 2/7 cohorts after chemotherapy without survival benefits in the remaining cohorts and investigated therapies. Limitations include the lack of controlled intervention studies, the heterogeneity and retrospective nature of the investigated populations. Conclusions This systematic review shows heterogenous therapeutic approaches in clinical practice without clear evidence for optimal oncologic management for patients with BM in EC.
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Affiliation(s)
- Martin Heidinger
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Elisa Simonnet
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Li Mei Koh
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Brigitte Frey Tirri
- Women’s Clinic, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Marcus Vetter
- University of Basel, Petersplatz 1, 4001 Basel, Switzerland
- Medical Oncology, Cantonal Hospital Baselland, Medical University Clinic, Muehlemattstrasse 13, 4410 Liestal, Switzerland
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Muacevic A, Adler JR, Pikoulis E, Tomos P, Nastos C. Synchronous Sternal Metastasectomy and Total Thyroidectomy for Differentiated Thyroid Cancer: A Rare Case Report. Cureus 2022; 14:e31294. [PMID: 36514611 PMCID: PMC9733711 DOI: 10.7759/cureus.31294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
Bone metastases from thyroid cancer are mainly rare, while sternal metastases are extremely uncommon. Bone metastases might be either synchronous or metachronous to primary thyroid cancer. A 60-year-old male patient presented to our department with a painful, fixed and firm sternal mass. Preoperative imaging studies, such as neck ultrasound (US) and computed tomography (CT) of the chest, revealed a 6.5 cm nodule of the right thyroid lobe with high-risk malignancy characteristics and a massive metastatic mass of the anterior mediastinal, which was extended from the sternal notch to the third intercostal space. The diagnosis of papillary thyroid carcinoma with sternal metastatic lesions was established. After meticulous discussion in the multidisciplinary board of our hospital, a total thyroidectomy plus en-bloc resection of this massive sternal metastasis and adjuvant radioiodine therapy were decided. Eight months postoperatively, no recurrence has occurred in this patient. R0 resection of isolated bone metastasis of thyroid origin is still an optimal therapeutic decision for these patients. In cases of sternal metastasis, radical surgical resection with negative margins, including both resection of the lesion and reconstruction of the chest wall, in order to successfully maintain the chest wall's stability, is recommended.
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Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, Saibene AM, Pipolo C, Fuccillo E, Rosso C, Felisati G, De Pasquale L. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol 2022; 12:954759. [PMID: 35875142 PMCID: PMC9300941 DOI: 10.3389/fonc.2022.954759] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review.
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Affiliation(s)
- Antonio Mario Bulfamante
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Eleonora Lori,
| | | | | | - Paolo Lozza
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Fuccillo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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8
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Staged surgical treatment for a giant hypervascular extra-intracranial metastasis of thyroid cancer using preoperative embolization and total microsurgical removal. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Qi L, Zhang W, Ren X, Xu R, Liu C, Tu C, Li Z. Incidence and Predictors of Synchronous Bone Metastasis in Newly Diagnosed Differentiated Thyroid Cancer: A Real-World Population-Based Study. Front Surg 2022; 9:778303. [PMID: 35141273 PMCID: PMC8819693 DOI: 10.3389/fsurg.2022.778303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Clinical and sociodemographic characteristics of differentiated thyroid cancer (DTC) patients with synchronous bone metastasis (SBM) remain unclear. This real-world study aimed to elucidate the incidence and prognosis of DTC patients with SBM using population-based data. Methods Data of patients with newly diagnosed DTC from 2010 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was utilized to identify predictors of developing SBM in patients with DTC and was further evaluated by receiver operator characteristics (ROC) analysis. Multivariable Cox regression was applied to identify prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS). Results A total of 67,176 patients with DTC were screened from the database, with 0.36% (244/67,176) developed SBM. The age-adjusted incidence of SBM in patients with DTC was relatively stable during the study period with an average annual percentage change (AAPC) of 2.52. Multivariable logistic regression analysis recognized seven factors (older age, male gender, black race, other races, follicular histology, the American Joint Committee on Cancer (AJCC) T2, T3, T4 staging, and N1 staging) as predictors of developing SBM among the entire cohort, with the value of area under the curve (AUC) of 0.931 (95% CI: 0.915–0.947). The median survival time of DTC patients with SBM was 22 months (interquartile range, 7–47 months). The multivariable Cox regression analysis indicated multiple metastatic sites, surgical procedures, and chemotherapy as predictors for the survival of patients. Conclusions Predictors and prognostic factors of SBM in patients with DTC were identified in this study. Patients with risk factors should be given more attention in clinical practice.
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Affiliation(s)
- Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Wenchao Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Xiaolei Ren
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Ruiling Xu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Chaoqian Liu
- Department of General Surgery, Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
- *Correspondence: Chao Tu
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
- Zhihong Li
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Kimario OM, Ngoya P, Otman O, Washington L, Massenga A, Abraham Z. Follicular thyroid carcinoma with an iliac wing metastasis - Rare case report at Bugando Medical Centre in Tanzania. Int J Surg Case Rep 2021; 89:106615. [PMID: 34864259 PMCID: PMC8645907 DOI: 10.1016/j.ijscr.2021.106615] [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: 09/22/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
Thyroid carcinoma is uncommon in our geographical setting. When it occurs the leading histological type is papillary thyroid carcinoma followed by follicular thyroid carcinoma which are differentiated thyroid carcinomas. Differentiated thyroid carcinomas usually have a good prognosis as compared to undifferentiated thyroid carcinomas. Follicular Thyroid Carcinoma usually presents with a solitary thyroid nodule with or without cervical lymphadenopathy. We present a 57 year old female with history of anterior neck swelling for 5 years and inability to walk using the left lower limb for 2 years. Total thyroidectomy and modified neck dissection was done. Histopathology results revealed follicular thyroid carcinoma. Patient was received radiochemotherapy treatment post-surgery. Follicular thyroid carcinoma may present with a symptomatic distant metastatic bony lesion as presented. It is important for clinicians to be aware this and carry out confirmatory relative investigations.
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Affiliation(s)
- Olivia Michael Kimario
- Department of Otorhinolaryngology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
| | - Patric Ngoya
- Department of Radiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Osca Otman
- Department of Pathology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Leonard Washington
- Department of General Surgery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alicia Massenga
- Department of General Surgery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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11
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Kato S, Demura S, Shinmura K, Yokogawa N, Shimizu T, Tsuchiya H. Current Management of Bone Metastases from Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13174429. [PMID: 34503240 PMCID: PMC8431580 DOI: 10.3390/cancers13174429] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC) can live longer than those with BMs from other cancers. BMs from DTC create destructive lesions and easily cause intractable pain and neurological symptoms, including paralysis. These symptoms related to BMs affect mortality directly and indirectly by hampering the application of systemic therapies. Therefore, long-term local control of BMs in patients with DTC is desired, especially in patients with single or a small number of metastases. Local treatments for BMs have recently become advanced and sophisticated in surgery, radiotherapy, and percutaneous procedures. These therapies, either alone or in combination with other treatments, can effectively improve, or prevent the deterioration of, the performance status and quality of life of patients with DTC-BM. Among local therapies, complete surgical resection and stereotactic radiosurgery are the mainstay for achieving long-term control of DTC-BM. Abstract After the lung, the skeleton is the second most common site of distant metastases in differentiated thyroid carcinoma (DTC). Patients with osteolytic bone metastases (BMs) from thyroid carcinoma often have significantly reduced performance status and quality of life. Recent advancements in cancer therapy have improved overall survival in multiple cancer subtypes, including thyroid cancer. Therefore, long-term local control of thyroid BMs is desired, especially in patients with a single metastasis or oligometastases. Here, we reviewed the current management options for DTC-BMs and especially focused on local treatments for long-term local tumor control from an orthopedic tumor surgeon’s point of view. Metastasectomy and stereotactic radiosurgery can be performed either alone or in combination with radioiodine therapy and kinase inhibitors to cure skeletal lesions in selected patients. Percutaneous procedures have been developed in recent years, and they can also have a curative role in small BMs. Recent advancements in local therapies have the potential to provide not only long-term local tumor control but also a better prognosis.
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12
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Clinical Indications for Treatment with Multi-Kinase Inhibitors in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13092279. [PMID: 34068664 PMCID: PMC8126102 DOI: 10.3390/cancers13092279] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Differentiated thyroid cancer is usually a slow-growing disease, even if the patients develop distant metastasis. For recurrent or metastatic disease, radioactive iodine therapy is a standard treatment. However, the disease gradually progresses in some of the patients and can ultimately develop into life-threatening conditions. For patients with progressive radioactive iodine-refractory differentiated thyroid cancer (RR-DTC), multi-kinase inhibitors (MKIs) including sorafenib and lenvatinib prolonged progression-free survival compared with placebo in pivotal randomized phase 3 trials, although the benefit in overall survival has not been clearly confirmed, possibly because the patients who received placebo were permitted to cross-over to lenvatinib upon disease progression. Moreover, the adverse events related to MKIs were not negligible. Therefore, the optimal timing of MKI initiation has long been controversial, and physicians should consider various patient and disease factors. Herein, we comprehensively review the clinical factors that can be helpful in determining the initiation of MKIs for patients with RR-DTC.
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13
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Pradeep S, Hedne N, Vidhyadharan S, Rajiv S. Sternal metastatectomy in a case of papillary thyroid carcinoma. BMJ Case Rep 2020; 13:13/10/e235967. [PMID: 33127692 DOI: 10.1136/bcr-2020-235967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroid cancer is the most common among endocrine cancers. Over 90% of all thyroid malignancies are differentiated thyroid carcinomas (DTC). However, only 2%-13% of DTC present with bone metastasis. Radioactive iodine ablation (RAI) is the treatment of choice for metastatic DTC. However, RAI therapy is not as effective in bone metastasis as it is in lung and visceral metastases. Only few cases of surgical management of bone metastasis in DTC have been reported in the literature. Here, we report a case of follicular variant of papillary thyroid carcinoma with sternal and lung metastases, for which sternal metastatectomy was performed.
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Affiliation(s)
- Sivakumar Pradeep
- Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Naveen Hedne
- Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Sivakumar Vidhyadharan
- Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Santosham Rajiv
- Cardiovascular and Thoracic Surgery, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
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14
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Yin LX, Puccinelli CL, Van Abel K, Kasperbauer JL, Price DL, Janus JR, Ryder M, Moore EJ. Prognostic Factors in Patients with Differentiated Thyroid Cancers Metastatic to the Cervical Spine. Laryngoscope 2020; 131:E1741-E1747. [PMID: 33095932 DOI: 10.1002/lary.29174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The spine is the most common site of bone metastases in differentiated thyroid cancer (DTC). The role of surgery in the management of cervical spine (C-spine) metastases (CSpM) has not been adequately explored. METHODS This is a retrospective cohort study at a tertiary referral center from 2002 to 2018. Inclusion criteria were pathologic diagnosis of DTC and imaging/pathologic diagnosis of CSpM. Statistical analysis utilized t tests for continuous variables and χ2 tests for categorical variables. Survival analysis was conducted using Kaplan-Meier curves with univariate and multivariate Cox regressions. RESULTS Fifty patients with DTC and CSpM were identified. Of those, 16 underwent surgical resection of the C-spine, whereas 34 did not. The most common presenting symptom was neck pain (N = 37, 74%). Patients in the surgery group were more likely to report a subjective improvement of symptoms (P < .01) and to have local (P < .01) and systemic (P = .04) disease control. Five-year overall survival was 44.7% for the surgery group (95% confidence interval [CI]: 17.1-69.3) and 11.1% (95% CI: 2.1-28.8) for the nonsurgery group (P = .01). The strongest risk factor for improved overall survival after C-spine metastasis was local disease control at the C-spine (multivariate hazard ratio [HR] = 0.32, 95% CI: 0.12-0.85, P = .02). Surgical intervention was significantly associated with improved survival on both univariate (HR = 0. 35, 95% CI: 0.15-0.82, P = .02) and multivariate (HR = 0.37, 95% CI: 0.14-0.98, P = .04) analysis. CONCLUSION Surgical management of CSpM in differentiated thyroid cancers is associated with significantly improved local disease control and overall survival. Referral to spine surgeons should be considered after diagnosis. LEVEL OF EVIDENCE IV. Laryngoscope, 131:E1741-E1747, 2021.
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Affiliation(s)
- Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Kathryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mabel Ryder
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
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15
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Concurrent Hip Pain and Skull Lump as the First Manifestations of a Silent Follicular Thyroid Carcinoma. REPORTS 2020. [DOI: 10.3390/reports3040027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Follicular thyroid carcinoma is a slowly growing cancer with a generally good long-term prognosis. Distant metastasis from follicular thyroid cancer usually occurs in the lung and bones following a long period after diagnosis and treatment for primary cancer. Occult skull metastasis as the first presentation at diagnosis from follicular thyroid cancer is relatively rare. A 51-year-old woman presented with intermittent pain in her right hip that was treated due to the intensely progressed pain, motor weakness, and difficulty walking. The patient was then referred due to swelling in the forehead. Further evaluation revealed that the frontal swelling and the pathological femoral fractures were manifestations of distant metastases from follicular thyroid cancer. In the presence of swelling in the skull, the metastatic lesion should be considered as a differential diagnosis from a silent primary cancer. This report will be beneficial for general practitioners, surgeons, and internists to recognize unusual distant metastatic manifestations from silent differentiated thyroid cancer.
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16
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Kondraciuk JD, Rice SL, Zhou X, Gharzeddine K, Knezevic A, Spratt DE, Sabra M, Larson SM, Grewal RK, Osborne JR. Thyroid Cancer Bone Metastasis: Survival and Genomic Characteristics of a Large Tertiary Care Cohort. Clin Nucl Med 2019; 44:e465-e471. [PMID: 31274625 PMCID: PMC6621602 DOI: 10.1097/rlu.0000000000002626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bone metastasis (BM) in differentiated thyroid cancer (DTC) is the second most common site of metastasis after lung. Bone metastases are associated with worse prognosis in DTC. In this study, we examined risk factors for overall survival in patients with BM and for the first time explore the pattern of genomic alterations in DTC BM. PATIENTS AND METHODS A Health Insurance Portability and Accountability Act (HIPAA) compliant, institutional review board-approved retrospective evaluation of the medical record was performed for all patients treated at a single institution for thyroid cancer over a 16-year period. Seventy-four patients met inclusion criteria. Multiple prognostic factors including age, sex, genes, radioactive iodine, and radiation or kinase inhibitor therapies were analyzed. Univariate and multivariate analyses were performed. RESULTS Treatment with external beam radiation was found to significantly increase survival (P = 0.03). The 5-year survival rate was 59% and median survival was 92 months. Patients who developed bone metastasis earlier tend to live longer (P = 0.06). The presence of TERT and BRAF mutations did not significantly worsen the prognosis (P = 0.10). CONCLUSION Patients with DTC can benefit from early treatment with external beam radiation therapy, especially those who develop bone metastasis within 3 years of primary TC diagnosis. Kinase inhibitor treatment tended to prolong survival but not in a statistically significant manner. Sex, age, and TERT or BRAF genetic mutations did not significantly affect the prognosis.
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Affiliation(s)
| | - Samuel L. Rice
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NL
| | - Xiaosun Zhou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karem Gharzeddine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Mona Sabra
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY
- Center for Targeted Radioimmunotherapy and Theranostics, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
| | - Ravinder K. Grewal
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
| | - Joseph R. Osborne
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
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17
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Zhang D, Gong H, Shen M, Wang D, Jiao J, Yang X, Liu T, Wei H, Wu Z, Xiao J. Surgical Management and Factors Affecting the Prognosis for Patients with Thyroid Cancer Spinal Metastases: A Retrospective Analysis of 52 Consecutive Patients from a Single Center. World Neurosurg 2019; 129:e330-e336. [PMID: 31132494 DOI: 10.1016/j.wneu.2019.05.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid cancer, one of the most common endocrine malignancies in developed areas and China, is associated with favorable prognosis. However, the presence of spinal metastases will remarkably reduce the life expectancy for patients with thyroid cancer. In addition, limited information is available about such disease. METHODS Various potential clinical factors were submitted to univariate and multivariate analyses to identify the independent variables that predicted the prognosis for patients. In addition, the survival rate was estimated according to the Kaplan-Meier method, and statistic differences were calculated by the log-rank test. Moreover, factors with a P value of ≤0.1 were performed multivariate analysis using a multivariate Cox proportional hazards model, and factors with a P value of <0.05 were considered as statistically significant. RESULTS Seven potential independent prognostic factors had been identified through univariate analysis, which were then subjected to multivariate analysis. Our results suggested that age of ≤50 years, single segment involved, and follicular thyroid cancer were the independent favorable prognostic factors. CONCLUSIONS Findings in this study indicate that age of ≤50 years, single segment involved, and follicular thyroid cancer are favorable prognostic factors for patients with thyroid cancer spinal metastases.
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Affiliation(s)
- Dan Zhang
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Haiyi Gong
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Mao Shen
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Da Wang
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jian Jiao
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tielong Liu
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Haifeng Wei
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhipeng Wu
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopaedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China.
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18
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Luo H, Tobey A, Auh S, Cochran C, Zemskova M, Reynolds J, Lima C, Burman K, Wartofsky L, Skarulis M, Kebebew E, Klubo-Gwiezdzinska J. The effect of lithium on the progression-free and overall survival in patients with metastatic differentiated thyroid cancer undergoing radioactive iodine therapy. Clin Endocrinol (Oxf) 2018; 89:481-488. [PMID: 29972703 PMCID: PMC6138537 DOI: 10.1111/cen.13806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pretreatment with lithium (Li) is associated with an increased residence time of radioactive iodine (RAI) in differentiated thyroid cancer (DTC) metastases. There are no data translating this observation into long-term outcomes. The study goal was to compare the efficacy of three methods of preparation for RAI therapy in metastatic DTC-thyroid hormone withdrawal (THW), THW with pretreatment with Li (THW+Li), and recombinant human TSH (rhTSH). DESIGN/PATIENTS/MEASUREMENTS We performed a cohort study comparing overall survival (OS) and progression-free survival (PFS) between the three groups: THW (n = 52), THW+Li (n = 41) and rhTSH (n = 42). Kaplan-Meier analyses were performed to compare OS and PFS between the groups. Cox proportional hazards regression model with a stepwise variable selection was performed to study the contribution of age, gender, histology, TNM status, a location of distant metastases and RAI dose. RESULTS During the follow-up of median 5.1 (IQR = 3.0-8.1) years, 52% of patients had disease progression and 12.6% died. Although THW+Li group was characterized by the longest OS (P = 0.007), only age (HR 1.05, CI 1.01-1.09, P = 0.01) and widespread disease (HR 3.8, CI 1.2-11.8, P = 0.02) were found to affect OS in a multivariate model. There was no difference in PFS between the groups (P = 0.47). Presence of distant metastases limited to the lungs only was associated with longer PFS (PFS HR 0.35, CI 0.20-0.60, P = 0.0002). CONCLUSION The older age is associated with shorter OS, while disease burden affects OS and PFS in patients with metastatic thyroid cancer. The method of preparation for RAI therapy does not affect the outcome.
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Affiliation(s)
- Hongxiu Luo
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Andrew Tobey
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Craig Cochran
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Marina Zemskova
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - James Reynolds
- Radiology and Imaging Sciences Department, NIH Clinical Center, Washigton, DC
| | - Cristiane Lima
- Endocrine Section, Medstar Washington Hospital Center, Washigton, DC
| | - Kenneth Burman
- Endocrine Section, Medstar Washington Hospital Center, Washigton, DC
| | - Leonard Wartofsky
- Endocrine Section, Medstar Washington Hospital Center, Washigton, DC
| | - Monica Skarulis
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Electron Kebebew
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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19
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Calcaneus Metastasis from Follicular Thyroid Carcinoma 12 Years after Total Thyroidectomy. Case Rep Orthop 2018; 2018:5281452. [PMID: 30228920 PMCID: PMC6136467 DOI: 10.1155/2018/5281452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/06/2018] [Indexed: 11/17/2022] Open
Abstract
We report the case of a sixty-eight-year-old female patient who presented for left ankle pain; X-rays and MRI showed a benign calcaneal cyst, found to be delayed distant metastasis from primary papillary thyroid carcinoma. Patient required surgical excision of the cyst. Results of histological examination showed metastatic papillary thyroid carcinoma. The patient underwent total thyroidectomy 12 years prior to presentation, with the same pathology. Postoperatively, she was treated with radioactive iodine. At 10-year follow-up post calcaneal mass excision, she was found to have a right proximal tibial mass and found to be recurrent with the same pathology. This case reports a rare condition that will be taken into consideration in bone metastasis with thyroid cancer.
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20
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Sheikh AB, Akhtar A, Tariq U, Sheikh AAE, Siddiqui FS, Bukhari MM. Skull Metastasis Extending to the Superior Sagittal Sinus: An Unfamiliar Presentation of Papillary Thyroid Carcinoma. Cureus 2018; 10:e2738. [PMID: 30087814 PMCID: PMC6075641 DOI: 10.7759/cureus.2738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thyroid cancer is the most common endocrine cancer in the world, with a rising global incidence over the last three decades. Papillary thyroid cancer (PTC) is the most common type of thyroid neoplasia, accounting for 74%-80% of all cases. Skull metastasis from a differentiated thyroid malignancy is a rare occurrence, while a subsequent dural involvement is even more inimitable. As such, a clinician requires a high degree of clinical suspicion and resultant radiographic evidence in order to make the diagnosis. Here we present the case of a 54-year-old male patient who presented with a pathological fracture of his right humerus, a midline frontal bone swelling and an asymptomatic neck mass. Further workup revealed follicular variant papillary thyroid carcinoma (FV-PTC) with distant metastasis to the calvarium. The conventional therapy for metastatic PTC includes a total thyroidectomy, removal of resectable metastatic lesions and a supplementation with radioactive iodine (RAI) and/or external beam radiation at the sites of the metastases. This case and our literature review illustrate that skull metastases should be considered in the clinical course of PTC so that appropriate management can be started.
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Affiliation(s)
| | - Aisha Akhtar
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | | | | | - Marvi M Bukhari
- Internal Medicine, Shifa College Of Medicine, Islamabad, PAK
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21
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Yonezawa N, Murakami H, Kato S, Hayashi H, Tsuchiya H. Successful treatment of a diffuse type tenosynovial giant cell tumor in the thoracic spine mimicking spinal metastasis by frozen recapping laminoplasty in a patient with thyroid cancer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:526-532. [PMID: 29663145 DOI: 10.1007/s00586-018-5603-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 04/12/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Tenosynovial giant cell tumor of the diffuse type (TGCT-D) involving the spine is rare. Its differential diagnosis includes metastatic disease; however, there have been few reports of spinal TGCT-D mimicking spinal metastasis in patients with a history of malignancy. METHODS We report on a 35-year-old woman with a history of papillary thyroid cancer who was diagnosed with TGCT-D of the thoracic spine mimicking spinal metastasis. Preoperative computed tomography (CT) revealed a 1.0 × 1.0-cm lytic bone lesion involving the left T7 vertebral lamina, pedicle, and the T6-7 facet joint; the thoracic spine lesion was markedly fluorodeoxyglucose-avid on positron-emission tomography/computed tomography (PET/CT). RESULTS Spinal metastasis was initially suspected given the patient's history of papillary thyroid cancer. Total excision was performed with recapping laminoplasty. The resected lamina was frozen in liquid nitrogen and used as a frozen autograft (frozen recapping laminoplasty) for spinal reconstruction with posterior instrumentation. Histological findings supported a diagnosis of TGCT-D. The patient had no evidence of local recurrence 2 years post-surgery. Bone union was achieved 3 years post-surgery. CONCLUSIONS TGCT-D can mimic metastasis in PET/CT and should be included in the differential diagnosis if a lytic lesion affecting the posterior elements of the vertebrae involves the facet joints. CT-guided biopsy is recommended for accurate diagnosis when an occult tumor, such as TGCT, is incidentally detected on PET-CT, even in patients with a history of malignant neoplasm. Frozen recapping laminoplasty is useful for complete resection of a spinal tumor, preventing local recurrence, and preservation of the posterior spinal elements.
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Affiliation(s)
- Noritaka Yonezawa
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Satoshi Kato
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Hayashi
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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22
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Acute paraparesis as presentation of an occult follicular thyroid carcinoma: A case report. Int J Surg Case Rep 2018; 41:498-501. [PMID: 29546026 PMCID: PMC5723273 DOI: 10.1016/j.ijscr.2017.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 11/23/2022] Open
Abstract
Follicular thyroid carcinoma is usually confined to the thyroid gland, but can metastasize. Signs and symptoms associated with bone metastasis are rare as first clinical manifestations. Complementary imaging studies, as TC and MRI, are very important, especially if bone metastases are suspected. Surgical procedure and ablative radioactive iodine therapy in these cases are key to achieve a better outcome. A low suspicion threshold for thyroid neoplasms must be taken into account when investigating metastasis to the bone.
Introduction Follicular thyroid carcinoma is the second most frequent type of well differentiated thyroid tumours. It is usually confined to the thyroid gland, however it can metastasize in a later stage of the disease. Signs and symptoms associated with bone metastasis are rare as first clinical manifestations. Case report An 84-year-old female complained with acute paraparesis. Magnetic resonance imaging revealed an extensive intraosseous infiltrating lesion compatible with a bone metastasis from an occult tumour. Biopsy samples were compatible with bone metastasis from a follicular thyroid carcinoma. The patient was submitted to total thyroidectomy followed by iodine ablative therapy. Discussion Follicular thyroid carcinoma presentation with symptoms related to bone metastasis is rare. Patients with bone lesions, such as pathological fractures or compressive symptoms should be studied since they may have clinically unapparent lesions from an unknown tumour. Patients with FTC should be submitted to total thyroidectomy. Bone lesions may be addressed to improve quality of life however this decision depends on disease extent. Conclusion Acute paraparesis is a rare form of presentation of thyroid carcinoma. These neoplasms must be taken into account when investigating metastasis to the bone from unknown neoplasms.
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Califano I, Deutsch S, Löwenstein A, Cabezón C, Pitoia F. Outcomes of patients with bone metastases from differentiated thyroid cancer. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:14-20. [PMID: 29694635 PMCID: PMC10118682 DOI: 10.20945/2359-3997000000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022]
Abstract
Objective Bone metastases (BM) from differentiated thyroid cancer (DTC) are associated with poor survival rates. Due to the low frequency of this entity, we performed a multicentric retrospective study that aimed to evaluate the presentation, outcome and causes of death in this population. Subjects and methods We reviewed file records from 10 databases. BM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. Results Fifty-two patients with DTC were included (44% male, mean age 54 years); 58% had papillary histology. BM were synchronous with DTC diagnosis in 46% of the participating cases. BM were symptomatic in 65% of the cases. Multiple BM were present in 65% of patients, while simultaneous metastatic disease in additional sites was found in 69%. Ninety-eight percent of patients received treatment for the BM, which included RAI therapy in 42 patients; 30 of them received cumulative RAI doses that were larger than 600 mCi 131I. The mean follow-up after a BM diagnosis was 34 months. The 2- and 5-year survival rates after diagnosis of the first BM were 64% and 38%, respectively. The status on the last evaluation was DTC-related death in 52% of the patients; 26% of them died from direct complications of BM or their treatments. Conclusion BM are usually radioiodine-refractory and are associated with a short overall survival, although most of the patients died of causes not directly related to the BM.
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24
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Mazziotti G, Formenti AM, Panarotto MB, Arvat E, Chiti A, Cuocolo A, Dottorini ME, Durante C, Agate L, Filetti S, Felicetti F, Filice A, Pace L, Pellegrino T, Rodari M, Salvatori M, Tranfaglia C, Versari A, Viola D, Frara S, Berruti A, Giustina A, Giubbini R. Real-life management and outcome of thyroid carcinoma-related bone metastases: results from a nationwide multicenter experience. Endocrine 2018; 59:90-101. [PMID: 29110129 DOI: 10.1007/s12020-017-1455-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE AND PATIENTS The M.O.S.CA.TI. (Metastases of the Skeleton from CArcinoma of the ThyroId) is a multicenter, retrospective study investigating the real-life outcome and management of bone metastases (BM) in 143 patients (63 M, 80 F; median age 64 years, range 11-87) with differentiated thyroid carcinoma (DTC). RESULTS Radio-active iodine (RAI) treatment was performed in 131 patients (91.6%), surgical approach and/or external radiotherapy in 68 patients (47.6%), and anti-resorptive bone-active drugs in 32 patients (22.4%; in 31 zoledronate and in one denosumab). At the start of treatment, 24 patients (75.0%) receiving anti-resorptive bone-active drugs had at least one clinical skeletal-related event (SRE) (p < 0.001). One or more clinical SREs (pathological fractures and/or malignant hypercalcemia and/or spinal cord compression) developed in 53 patients (37.1%). Development of SREs was significantly associated with metachronous BM (hazard ratio (HR) 2.04; p = 0.04), localization of BM to cervical spine (HR 3.89; p = 0.01), and lack of avid RAI uptake (HR 2.66; p = 0.02). Thirty-nine patients (27.3%) died in correlation with development of SREs (HR 6.97; p = 0.006) and localization of BM to the hip (HR 3.86; p = 0.02). Moreover, overall mortality was significantly decreased by RAI therapy (HR 0.10; p = 0.02), whereas no significant effects were induced by bone-active drugs (p = 0.36), external radiotherapy (p = 0.54), and surgery (p = 0.43) of BM. CONCLUSIONS SREs are very frequent in BM from DTC and they impact patient survival. In the real life, the use of bone-active drugs is currently limited to zoledronate in patients with pre-existing SREs. In this clinical setting, RAI therapy, but not zoledronate, decreased mortality.
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Affiliation(s)
- G Mazziotti
- Endocrine Unit, ASST Carlo Poma, Mantua, Italy
| | - A M Formenti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M B Panarotto
- Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - E Arvat
- Oncological Endocrinology, University of Turin, Torino, Italy
| | - A Chiti
- Nuclear Medicine, Humanitas Research Hospital and Humanitas University, Milan, Italy
- Humanitas University, Milan, Italy
| | - A Cuocolo
- Nuclear Medicine, University of Naples Federico II, Napoli, Italy
| | - M E Dottorini
- Nuclear Medicine, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - C Durante
- Internal Medicine, University Sapienza of Rome, Roma, Italy
| | - L Agate
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Filetti
- Internal Medicine, University Sapienza of Rome, Roma, Italy
| | - F Felicetti
- Oncological Endocrinology, University of Turin, Torino, Italy
| | - A Filice
- Nuclear Medicine, Azienda Ospedaliera Santa Maria Nuova-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - L Pace
- Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - T Pellegrino
- Institute of Biostructure and Bioimaging of the National Research Council of Italy-CNR, Naples, Italy
| | - M Rodari
- Nuclear Medicine, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - M Salvatori
- Nuclear Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - C Tranfaglia
- Nuclear Medicine, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - A Versari
- Nuclear Medicine, Azienda Ospedaliera Santa Maria Nuova-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - D Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Frara
- San Raffaele Vita-Salute University, Milan, Italy
| | - A Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - A Giustina
- San Raffaele Vita-Salute University, Milan, Italy.
| | - R Giubbini
- Nuclear Medicine, ASST Spedali Civili of Brescia, Brescia, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
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25
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Osorio M, Moubayed SP, Su H, Urken ML. Systematic review of site distribution of bone metastases in differentiated thyroid cancer. Head Neck 2017; 39:812-818. [DOI: 10.1002/hed.24655] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marcela Osorio
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Sami P. Moubayed
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
| | - Henry Su
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Mark L. Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
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26
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Kim M, Kim WG, Park S, Kwon H, Jeon MJ, Lee JJ, Ryu JS, Kim TY, Shong YK, Kim WB. Initial Size of Metastatic Lesions Is Best Prognostic Factor in Patients with Metastatic Differentiated Thyroid Carcinoma Confined to the Lung. Thyroid 2017; 27:49-58. [PMID: 27750021 DOI: 10.1089/thy.2016.0347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND For patients with lung metastases of differentiated thyroid carcinoma (DTC), there is no consensus on the maximal size of metastatic lesions to use when determining the intensity of follow-up and additional therapeutic options. This study evaluated the clinical outcomes and survival of patients with metastatic DTC confined to the lung, using the maximal diameter of lung lesions in the initial computed tomography. METHODS This retrospective cohort study included 112 DTC patients with metastases confined to the lung. The clinical responses were evaluated according to changes in the serum levels of stimulated thyroglobulin or antithyroglobulin antibody, disease status was evaluated according to radiological findings, progression-free survival (PFS), and cancer-specific survival (CSS). RESULTS Macronodular lung metastases (≥1 cm) were observed in 27 (24%) patients, and these patients had significantly poor biochemical responses and disease status (p < 0.001, and p < 0.001, respectively), irrespective of radioactive iodine (RAI) avidity. After adjusting for age, sex, primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, time of lung metastasis, and RAI avidity, the macronodular group also had shorter PFS and CSS (p = 0.009 and p = 0.03, respectively) than the micronodular group. From the multivariate analyses, RAI avidity was not an independent prognostic factor predicting PFS and CSS. In the subgroup analyses, RAI avidity was a significant prognostic factor associated with better PFS and CSS (p = 0.013 and p = 0.021, respectively) in the micronodular group only. CONCLUSIONS The initial largest diameter of metastatic lesions is the most important prognostic factor for predicting poor clinical outcomes and survival in patients with metastatic DTC confined to the lung.
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Affiliation(s)
- Mijin Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Gu Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Suyeon Park
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hyemi Kwon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Min Ji Jeon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jong Jin Lee
- 2 Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jin-Sook Ryu
- 2 Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae Yong Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Kee Shong
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Bae Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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27
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Bernstein MB, Chang EL, Amini B, Pan H, Cabanillas M, Wang XA, Allen PK, Rhines LD, Tatsui C, Li J, Brown PD, Ghia AJ. Spine Stereotactic Radiosurgery for Patients with Metastatic Thyroid Cancer: Secondary Analysis of Phase I/II Trials. Thyroid 2016; 26:1269-75. [PMID: 27334245 DOI: 10.1089/thy.2016.0046] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Metastatic deposits to the spine in thyroid cancer patients represent the most common site of bone involvement and can contribute to pain, neurologic deficits, and death. This study sought to determine the efficacy and safety of spine stereotactic radiosurgery (SSRS) for thyroid cancer patients. METHODS Thyroid cancer patients with spine metastases were selected and analyzed from a cohort of patients who were prospectively enrolled in two single-institution Phase I/II studies. SSRS was delivered in single or multi-fraction schedules. Dose regimens ranged from 16-18 Gy in one fraction to 27-30 Gy in three to five fractions. Toxicity was graded according to the NCI-CTC toxicity scale. Local control was determined by serial post-treatment magnetic resonance imaging scans showing no evidence of progressive disease. Patients were followed until date of death or date of last known visit for survival analyses. Local control and overall survival rates were carried out using Kaplan-Meier estimates. The log-rank test was used to assess the equality of the survivor function across groups. A p-value of ≤0.05 was considered to be statistically significant. RESULTS A total of 27 spine lesions were treated in 23 patients over a six-year period. Median follow-up was 28.9 months (range 5-93 months). Local control was 88% at two years and 79% at three years. In patients with progressive disease following conventional radiation therapy, local control for salvage SSRS remained at 88% at three years. Patients requiring upfront surgical intervention and treated with adjuvant SSRS achieved sustained control rates of 86% at three years. Overall survival rates were 85% and 67% at one and two years, respectively. In patients classified with oligoprogression and controlled extra-spinal disease, overall survival was significantly higher than those with evidence of systemic progression (81% vs. 45% at two years; p = 0.01). Univariate analysis did not show significant correlations between local control and age, systemic disease status, prior (131)I therapy, SSRS fraction regimen, spine location, histological subtype, or time from initial diagnosis to evidence of spinal metastasis. No patient experienced any grade 3-5 toxicity. Pain flare was reported in 30% of patients, with only three patients (13%) requiring narcotics or short-course steroids. There was no evidence of vertebral body fracture in any patient that achieved local control in the treated area. CONCLUSIONS SSRS for thyroid metastases as a primary or adjuvant/salvage therapy is well tolerated and yields high rates of local control.
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Affiliation(s)
- Michael B Bernstein
- 1 Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Eric L Chang
- 2 Department of Radiation Oncology, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Behrang Amini
- 3 Division of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Hubert Pan
- 1 Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Maria Cabanillas
- 4 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Xin A Wang
- 5 Division of Radiation Physics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Pamela K Allen
- 1 Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Laurence D Rhines
- 6 Division of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Claudio Tatsui
- 6 Division of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Jing Li
- 1 Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Paul D Brown
- 1 Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Amol J Ghia
- 1 Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas
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Kato S, Murakami H, Demura S, Fujimaki Y, Yoshioka K, Yokogawa N, Tsuchiya H. The impact of complete surgical resection of spinal metastases on the survival of patients with thyroid cancer. Cancer Med 2016; 5:2343-9. [PMID: 27431619 PMCID: PMC5055174 DOI: 10.1002/cam4.823] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/03/2023] Open
Abstract
Spinal metastases (SMs) from thyroid cancers significantly reduce the quality of life by causing pain and neurological deficits and increase mortality. Complete surgical resection of isolated thyroid SMs is a promising treatment option; however, the postoperative outcome is unknown. This study aimed to compare the postoperative courses of patients undergoing complete resection of thyroid SMs with those of patients undergoing incomplete resection, with a minimum 4‐year follow‐up. We performed a retrospective analysis of 32 patients who underwent tumor excision surgery for thyroid SMs at our medical center during a 28‐year period. Twenty patients underwent complete excision, and 12 underwent incomplete excision. Survival was defined as the time from the first spinal surgery to death or last follow‐up. Kaplan–Meier analysis with the long‐rank test was used to compare the overall survival rates between the groups. For all patients, the overall 5‐ and 10‐year survival rates were 71% and 31%, respectively. The median overall survival time was 6.4 years. The patients undergoing complete excision survived longer than those undergoing incomplete excision (5‐year survival: 84% vs. 50%; 10‐year survival: 52% vs. 8%; P < 0.01). Only one patient undergoing complete excision experienced local tumor recurrence in the operated spine, whereas all long‐term survivors (>18 months after surgery) in the incomplete excision group experienced local tumor recurrence and a consequent deterioration in performance status. Complete surgical resection of thyroid SMs, if achievable, has the potential not only to maintain performance status, but also to prolong survival.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yoshiyasu Fujimaki
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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29
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Mishra A, Kumar C, Chand G, Agarwal G, Agarwal A, Verma AK, Mishra SK. Long-Term Outcome of Follicular Thyroid Carcinoma in Patients Undergoing Surgical Intervention for Skeletal Metastases. World J Surg 2016; 40:562-9. [DOI: 10.1007/s00268-016-3402-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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31
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8470] [Impact Index Per Article: 1058.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Mizoshiri N, Shirai T, Terauchi R, Tsuchida S, Mori Y, Saito M, Ueshima K, Kubo T. Metastasis of differentiated thyroid cancer in the subchondral bone of the femoral head: a case report. BMC Musculoskelet Disord 2015; 16:286. [PMID: 26452365 PMCID: PMC4600274 DOI: 10.1186/s12891-015-0748-2] [Citation(s) in RCA: 2] [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: 07/14/2015] [Accepted: 10/03/2015] [Indexed: 12/22/2022] Open
Abstract
Background Differentiated thyroid cancer (DTC) is relatively rare and can metastasize to both the lungs and bones. The great majority of bone metastases occur in red marrow regions where blood flow is high. Only one patient has been described with direct DTC metastasis to the subchondral bone of the femoral head. Case presentation The patient was a 68-year-old Japanese female who had presented with left hip joint pain at age 63 years. At age 51 years, she had been diagnosed with DTC and underwent partial excision. X-rays showed partial femoral head collapse, suggesting osteoarthritis or idiopathic necrosis of the left femoral head. Three years later, a 131 I whole-body scan showed accumulation in the left femoral head, resulting in a diagnosis of DTC metastasis to the left femoral head. Bipolar hip arthroplasty was performed. Examination of the excised femoral head resulted in a final diagnosis of metastasis of follicular thyroid cancer, which was limited histopathologically to the subchondral bone of the femoral head. Conclusion Tumor metastasis to the subchondral bone of the femoral head is exceedingly rare. Overall survival of patients with bone metastasis is improved by complete resection. Differential diagnosis of patients with a previous history of DTC who present with femoral head collapse should include bone metastasis of DTC.
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Affiliation(s)
- Naoki Mizoshiri
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Yuki Mori
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Masazumi Saito
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Keiichiro Ueshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Krishnamurthy A. Clavicle metastasis from carcinoma thyroid- an atypical skeletal event and a management dilemma. Indian J Surg Oncol 2015; 6:267-70. [PMID: 27217676 PMCID: PMC4856680 DOI: 10.1007/s13193-015-0387-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
Bone metastases is a well described event in the natural history of thyroid cancers and has the potential to severely impact the quality of life by causing pain, fractures and spinal cord compression. Follicular thyroid carcinomas have a greater propensity for distal metastasis than papillary and anaplastic thyroid carcinomas. The most common sites of skeletal metastasis among thyroid cancer patients are femur followed by humerus, pelvis, radius, and scapula. Clavicle metastasis at initial presentation is exceedingly rare. Although many studies have examined the various prognostic factors for patients with bony metastases from thyroid cancers, very few have actually evaluated the effects of surgical management. We present an unusual case of metastatic papillary carcinoma thyroid presenting with clavicle metastasis and review the role of surgical management of bone metastases. Clavicular resection as a part of the management of metastatic papillary carcinoma thyroid has, to the best of our knowledge never been reported before.
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Affiliation(s)
- Arvind Krishnamurthy
- Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai 600036 India
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34
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Kim HJ, Lee JI, Kim NK, Min YK, Kim SW, Chung JH. Prognostic implications of radioiodine avidity and serum thyroglobulin in differentiated thyroid carcinoma with distant metastasis. World J Surg 2015; 37:2845-52. [PMID: 24085223 DOI: 10.1007/s00268-013-2213-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although differentiated thyroid carcinoma (DTC) rarely develops distant metastases, the present study was performed to evaluate factors that affect the survival of patients with DTC who present with distant metastasis. METHODS Among 4,989 patients who underwent thyroid surgery for DTC, 82 presenting with distant metastasis were analyzed. Based on radioiodine ((131)I) avidity and the thyroid-stimulating hormone-stimulated serum thyroglobulin (sTg) level at the time of metastasis, patients were divided into three groups: group 1 ((131)I uptake + sTg ≤ 215 ng/mL, n = 46), group 2 ((131)I uptake + sTg > 215 ng/mL, n = 24), group 3 (no (131)I uptake, n = 12). Disease-specific survival (DSS) was estimated using the Kaplan-Meier method. Factors predicting the outcome were evaluated using Cox proportional hazard regression analysis. RESULTS The age of patients (p = 0.04), frequency of follicular thyroid carcinoma (p = 0.002), tumor size (p < 0.001), and number of multiple metastatic sites (p = 0.004) differed significantly among the groups. With a median follow-up after surgery of 72 months, the 5- and 10-year DSSs for all patients were 84 and 69 %, respectively. The predictors of survival were age (p = 0.004), symptoms at the time of presentation (p = 0.045), histology (p = 0.01), sites of metastasis (p = 0.03), and (131)I avidity and sTg level at the time of metastasis (p = 0.002). In the multivariate analysis, age, histology, and (131)I avidity and sTg level at the time of metastasis remained significant factors for survival. CONCLUSIONS Certain DTC patients with distant metastasis demonstrate favorable outcomes dependent on age, histology, and (131)I avidity and sTg level at the time of metastasis.
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Affiliation(s)
- Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea,
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35
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Thyroid Cancer. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Son HY, An SY, Kim EY, Ahn SB, Lee BC. Selective embolization for hypervascular metastasis from differentiated thyroid cancer: a case series. J Med Case Rep 2014; 8:405. [PMID: 25471328 PMCID: PMC4289282 DOI: 10.1186/1752-1947-8-405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/14/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction The technique of selective embolization has been applied for years in the treatment of vascular anomalies, severe hemorrhage, and for benign and malignant tumors. Some hypervascular skeletal metastases are prone to massive hemorrhage. Case presentation We describe the cases of two patients with thyroid carcinoma presenting with neuromuscular symptoms due to large skeletal metastases in the shoulder and sternum respectively. Pre-operative percutaneous selective catheterizations of the arteries feeding the metastatic tumors were performed, followed by infusion of gelfoam. The procedures were technically successful in both patients without adverse effects or bleeding. Complete resections of the skeletal metastases were then performed without substantial bleeding. Conclusion Selective embolization is an effective treatment for bony metastases from thyroid cancer.
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Affiliation(s)
- Hee Young Son
- Department of Otorhinolaryngology, Thyroid/Head & Neck Cancer Center, Dongnam Institution of Radiological & Medical Sciences, 40 Jwadong-gil, Jangan-eup, Gijang-gun, Busan, South Korea.
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37
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Kushchayeva YS, Kushchayev SV, Carroll NM, Felger EA, Links TP, Teytelboym OM, Bonichon F, Preul MC, Sonntag VKH, Van Nostrand D, Burman KD, Boyle LM. Spinal metastases due to thyroid carcinoma: an analysis of 202 patients. Thyroid 2014; 24:1488-500. [PMID: 24921429 DOI: 10.1089/thy.2013.0633] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Spinal metastases (SMs) due to thyroid cancer (TC) are associated with significantly reduced quality of life. The goal of this study is to analyze the clinical manifestations, presentation, and treatments of TC SMs, and to describe specific features of SMs associated with different TC types. PATIENTS AND METHODS A retrospective analysis of 202 TC SM patients treated at Medstar Washington Hospital Center (37) and collected from the literature (165) was performed. RESULTS The mean age of patients with SMs was 56.9±14.7 years, and the female-to-male ratio was 2.1:1. Of all patients, 29% (28% of follicular thyroid cancer [FTC] and 37% of papillary thyroid cancer [PTC]) had SMs only. Twenty-nine percent of all patients and 54% of patients with single-site SMs had neither bone non-SMs nor solid organ metastases at the time of presentation. Thirty-five percent of patients had SMs as an initial presentation of TC. TC patients presenting with SMs had a lower rate of other bone and visceral involvement compared with patients whose SMs were diagnosed at the time of thyroid surgery or during follow-up (p<0.05). SMs were more often the initial manifestation of FTC (41% vs. 24%), while PTC SMs were more commonly diagnosed after TC diagnosis (76% vs. 59%; p<0.05). PTC SMs were more frequently diagnosed as synchronous (63% vs. 36% in FTC) versus FTC SMs that developed as metachronous metastases (64% vs. 37% in PTC; p<0.01). All FTC SMs developed within 82 (0-372) months and all PTC SMs within 35 (0-144) months (p<0.01). In FTC SMs as TC manifestation, solid organ metastases involvement was less common than in FTC SMs that were found after TC diagnosis (34% vs. 67%; p<0.01); multisite FTC SMs compared to solitary FTC SMs were associated with the development of other bone nonspinal metastases (82% vs. 30%; p<0.01) and solitary organ metastases (65% vs. 41%; p<0.01). These correlations were not observed in PTC SMs. FTC patients often had neural structure compression (myelopathy/radiculopathy; 72% vs. 36% in PTC), while PTC patients frequently were asymptomatic (38% vs. 5% in FTC; p<0.01). FTC SMs more commonly were (131)I-avid (p<0.01). FTC patients required surgery more frequently (72% vs. 55% in PTC; p<0.05). CONCLUSIONS Our study reveals that a significant part of TC SMs patients have solitary spinal involvement at the time of presentation and may be considered for aggressive treatment with the intention to improve quality of life and survival. FTC SMs and PTC SMs appear to have distinct presentations, behavior, and treatment modalities, and should be categorized separately for treatment and follow-up planning.
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Affiliation(s)
- Yevgeniya S Kushchayeva
- 1 Department of Internal Medicine and Surgery, Medstar Washington Hospital Center , Washington, District of Columbia
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Kushchayeva YS, Kushchayev SV, Wexler JA, Carroll NM, Preul MC, Teytelboym OM, Sonntag VKH, Van Nostrand D, Burman KD, Boyle LM. Current treatment modalities for spinal metastases secondary to thyroid carcinoma. Thyroid 2014; 24:1443-55. [PMID: 24827757 DOI: 10.1089/thy.2013.0634] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The spine is the most common site of bone metastases due to thyroid cancer, which develop in more than 3% of patients with well-differentiated thyroid cancer. Nearly half of patients with bone metastases from thyroid cancer develop vertebral metastases. Spinal metastases are associated with significantly reduced quality of life due to pain, neurological deficit, and increased mortality. SUMMARY Treatment options for patients with thyroid spinal metastases include radioiodine therapy, pharmacologic therapy, and surgical treatments, with recent advances in radiosurgery and minimally invasive spinal surgery as well. Therapeutic interventions require a multidisciplinary approach and aim to control pain, preserve or improve neurologic function, optimize local tumor control, and improve quality of life. We have proposed a three-tiered approach to the management and practical algorithms for patients with spinal metastases from thyroid carcinoma. CONCLUSIONS The introduction of novel and improved techniques for the treatment of spinal metastases has created the opportunity to significantly improve control of metastatic tumor growth and the quality of life for the patients with spinal metastases from thyroid cancer. In order for these options to be effectively used, a multidisciplinary approach must be applied in the management of the patients with thyroid spinal metastases.
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Affiliation(s)
- Yevgeniya S Kushchayeva
- 1 Department of Internal Medicine, MedStar Washington Hospital Center , Washington, District of Columbia
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Robenshtok E, Farooki A, Grewal RK, Tuttle RM. Natural history of small radioiodine-avid bone metastases that have no structural correlate on imaging studies. Endocrine 2014; 47:266-72. [PMID: 24366637 DOI: 10.1007/s12020-013-0123-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
Bone metastases from differentiated thyroid cancer are generally resistant to radioiodine (RAI) therapy and are associated with poor prognosis. However, in a recent study from our group we noted a small subgroup of patients with RAI-avid bone metastases who had no structural correlate on imaging studies, and had no skeletal complications during follow-up. The purpose of this study was to better define the natural history and outcome of these patients. In a retrospective review of medical records at Memorial Sloan-Kettering Cancer Center, 288 patients were identified with bone metastases from thyroid cancer between 1960 and 2011. Out of this group, 14 patients who had a RAI-avid bone metastasis without structural correlate on CT or MRI were included in the study. After a median follow-up period of 5 years (range 2-14 years) all patients were alive, none had evidence of structural bone metastases, and none had experienced skeletal-related events. The final disease status was: no evidence of disease in 6 patients (43 %), stable biochemical persistence in 2 patients (14 %), stable structural disease in 5 patients (36 %), and one patient with slowly progressive disease. To conclude, RAI-avid bone metastases with no structural correlate on high-resolution imaging studies often resolve following RAI treatment, do not cause skeletal-related complications, and do not have a major prognostic significance. Recognition of this unique type of bone metastases is important as it is not associated with the same poor prognosis and resistance to RAI therapy that is associated with structurally identifiable bone metastases.
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Affiliation(s)
- Eyal Robenshtok
- Endocrinology, Memorial Sloan Kettering Cancer Center, New York, 10021, USA,
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Nakayama R, Horiuchi K, Susa M, Watanabe I, Watanabe K, Tsuji T, Matsumoto M, Toyama Y, Morioka H. Clinical outcome after bone metastasis (BM) surgery in patients with differentiated thyroid carcinoma (DTC): a retrospective study of 40 cases. Jpn J Clin Oncol 2014; 44:918-25. [PMID: 25104791 DOI: 10.1093/jjco/hyu099] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study is to identify factors that affect survival of patients with differentiated thyroid carcinoma with bone metastases and to optimize surgical treatment modality for bone metastatic lesion by comparing duration of patient survival and local control. METHODS We examined 52 bone metastatic lesions from 40 patients with differentiated thyroid carcinoma who were treated surgically between 1994 and 2008 at Keio University Hospital. Median follow-up time was 46 months (range: 4-233 months). Patients' disease-specific survival, local control duration and factors that potentially affected disease-specific survival after bone metastasis surgery were statistically analyzed. RESULTS The 2-, 5- and 10-year disease-specific survival rates were 77.2, 64.3 and 45.7%, respectively. Factors that were significantly associated with poor survival rates in multivariate analyses included age at bone metastasis surgery ≥65 years (P = 0.0068), time from diagnosis of primary cancer to bone metastasis surgery ≥5 years (P = 0.0018) and presence of visceral metastases (P = 0.0092). The 2-, 5- and 10-year local control rates in our series were 91.4, 72.7 and 63.6%, respectively. The 5-year local control rates for radical and palliative surgery were 84.4 and 55.3%, respectively, and differed significantly (P = 0.019). CONCLUSIONS Because disease-specific survival of patients with differentiated thyroid carcinoma is fairly good, inadequate treatment of bone metastatic lesions can result in severe disabilities. Therefore, radical surgery for bone metastatic lesions should be considered, especially for those with favorable prognostic factors.
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Affiliation(s)
- Robert Nakayama
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Metastasis of thyroid cancer to the sternum after total thyroidectomy and laryngectomy. Case Rep Surg 2013; 2013:346246. [PMID: 24159407 PMCID: PMC3789499 DOI: 10.1155/2013/346246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/14/2013] [Indexed: 11/17/2022] Open
Abstract
Metastasis of thyroid cancer to the sternum is rare. Ablation is the therapy of choice for patients with metastasizing differentiated thyroid cancer, while surgical resection is an option for those with resectable bony metastasis. This report describes a case of a 65-year-old woman with a sternal tumor. The patient was treated by partial sternal resection and sternal reconstruction with new material polypropylene/expanded polytetrafluoroethylene (ePTFE) composite. The postoperative course was uneventful, and she was free of recurrence after 1 year of follow-up. We conclude that surgery should be used to manage solid bony metastasis from thyroid papillary carcinoma. Further more, a polypropylene/ePTFE composite may be useful for sternal reconstruction after thoracotomy.
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Koppad SN, Kapoor VB. Follicular thyroid carcinoma presenting as massive skull metastasis: a rare case report and literature review. J Surg Tech Case Rep 2013; 4:112-4. [PMID: 23741589 PMCID: PMC3673353 DOI: 10.4103/2006-8808.110252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Follicular carcinoma of thyroid is a well differentiated thyroid malignancy. It is slow growing in nature and tends to metastasize to remote organs in advanced stage by hematogenous route. Lung and bone are the two most common sites of metastasis. In most of the reported cases of follicular thyroid carcinoma metastasizing to the skull, metastases occurred long after the diagnosis and institution of treatment for primary cancer. Very few cases have been reported with occult follicular thyroid carcinoma presenting as skull metastasis. A 48-year-old female patient presented with massive swelling in the frontal region of skull associated with swellings in occipital region. Evaluation confirmed that it is multiple metastases to skull bones from follicular thyroid carcinoma. This is a very rare presentation with such a large size of metastasis. We report this case of a metastatic follicular thyroid carcinoma presenting as massive skull tumor at our institution.
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Affiliation(s)
- Sanjay N Koppad
- Department of General Surgery, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
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Abstract
Advanced differentiated thyroid cancer (DTC), defined by clinical characteristics including gross extrathyroidal invasion, distant metastases, radioiodine (RAI) resistance, and avidity for 18-fluorodeoxyglucose (positron emission tomography-positive), is found in approximately 10-20% of patients with DTC. Standard therapy (surgery, RAI, TSH suppression with levothyroxine) is ineffective for many of these patients, as is standard chemotherapy. Our understanding of the molecular mechanisms leading to DTC and the transformation to advanced DTC has rapidly evolved over the past 15-20 years. Newer targeted therapy, specifically inhibitors of intracellular kinase signaling pathways, and cooperative multicenter clinical trials have dramatically changed the therapeutic landscape for patients with advanced DTC. In this review focusing on morbidities, molecules, and medicinals, we present a patient with advanced DTC, explore the genetics and molecular biology of advanced DTC, and review evolving therapies for these patients including multikinase inhibitors, selective kinase inhibitors, and combination therapies.
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Affiliation(s)
- Bryan R Haugen
- University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, Colorado 80045, USA.
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Rosário PW, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, Maia AL, Vaisman M. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. ACTA ACUST UNITED AC 2013; 57:240-64. [DOI: 10.1590/s0004-27302013000400002] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Indexed: 12/11/2022]
Abstract
Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature.
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Affiliation(s)
| | | | | | - Hans Graf
- Universidade Federal do Paraná, Brazil
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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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Hajjar WM, Alnassar S, Abu-Daff SN, Al-Dhahri SF. A novel technique for the reconstruction of resected sternoclavicular joints: A case report with a review of the literature. Ann Thorac Med 2013; 8:60-3. [PMID: 23440949 PMCID: PMC3573561 DOI: 10.4103/1817-1737.105722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/13/2012] [Indexed: 12/04/2022] Open
Abstract
Sternal metastasis in thyroid cancer is an uncommon occurrence with only a handful of cases of chest wall resections being done. Sternal reconstruction for both primary and secondary tumors has been performed using various techniques and materials such as the mesh, methyl acrylate resin, and steel plates; however, this is a case of papillary thyroid cancer involving the sternum in a 50-year-old woman who had resection of the sternum with reconstruction using titanium bars and clips (STRATOS system) fixed to the clavicles with an underlying Proceed mesh. STRATOS system showed good recovery postoperatively. The functional results were excellent with the patient being able to perform all daily activities unassisted after 1 month and almost complete range of motion with acceptable limitations in power of the shoulder muscles after 2 months. We have reviewed all the English language publications of the subject by doing Medline search for the last 25 years and we present here the surgical management of this pathology with our novel approach by using the titanium steel bars to stabilize both medial aspects of the resected clavicles as a promising therapy for manubrial reconstruction and clavicular fixation.
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Affiliation(s)
- Waseem M Hajjar
- Department of Surgery College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Damle N, Patnecha M, Kumar P, Maharjan S, Bal C. Retinoic acid therapy in patients with radioiodine negative differentiated thyroid cancer and clinical or biochemical evidence of disease: An initial experience. Indian J Nucl Med 2013; 26:144-8. [PMID: 23326066 PMCID: PMC3543580 DOI: 10.4103/0972-3919.103997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dedifferentiation of thyroid follicular cells renders radioiodine therapy ineffective in patients of differentiated thyroid cancer (DTC). An alternative therapy to treat the disease or reinduce radioiodine uptake is necessary. MATERIALS AND METHODS We evaluated the role of retinoic acid therapy in 13 cases of DTC with raised thyroglobulin and/or clinically evident disease. Retinoic acid was given in a dose of 1.5 mg/kg for a period ranging between 1.5 and 18 months. RESULTS Age of the patients was between 18 and 65 years with a median of 49 years. Ten patients had papillary while two had follicular and one patient had mixed papillary and follicular thyroid cancer. Mean radioiodine given before starting retinoic acid was 164 mCi. Mean duration of therapy was 6.4 months. Thyroglobulin decreased in 2 patients and increased in 11 patients at the end of therapy. Radioiodine uptake was demonstrable in six patients, though faintly, while 7 cases showed no uptake. Based on the clinical and biochemical parameters, four patients had progressive disease, eight had stable disease and one patient showed partial response. Of the six patients with reinduction of radioiodine uptake, three had biochemical progression and the other three had stable disease. CONCLUSION Our findings suggest that retinoic acid therapy may induce radioiodine uptake and reduce serum thyroglobulin levels in some patients with DTC, but whether this results in clinically significant response can only be ascertained on long-term follow-up.
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Affiliation(s)
- Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Femoral Pathological Fracture as the First Clinical Manifestation of Papillary Thyroid Carcinoma in a Primigravida. Case Rep Pathol 2013; 2013:397361. [PMID: 23691401 PMCID: PMC3638500 DOI: 10.1155/2013/397361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/24/2013] [Indexed: 11/17/2022] Open
Abstract
Papillary thyroid carcinoma is the most common differentiated type of thyroid malignancy. It is largely a loco-regional disease with a high tendency to metastasize to regional cervical lymph nodes. Distant hematogenous metastases are very rare and primarily include lungs and bones. Distant bone metastases are present in approximately 1.7% of patients with differentiated thyroid malignancy. Sternum, ribs, and spine are the most frequent sites of osseous metastases. Up to our knowledge, we report the first occurrence of an extra nodal metastasis of papillary thyroid carcinoma to a femoral bone presenting as a pathological fracture in a 21-year-old 37-week primigravida. We report this case because of its unusual site of metastasis and atypical presentation during pregnancy. Moreover, we briefly elaborate on the management of such uncommon cases.
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Surgical management of appendicular skeletal metastases in thyroid carcinoma. Int J Surg Oncol 2012; 2012:417086. [PMID: 23304478 PMCID: PMC3530792 DOI: 10.1155/2012/417086] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/16/2012] [Accepted: 10/30/2012] [Indexed: 11/18/2022] Open
Abstract
Background. Bone is a frequent site of metastasis from thyroid carcinoma, but prognostic factors for patients who have surgery for thyroid carcinoma bone metastases are poorly understood. Methods. A retrospective review at a single institution identified 41 patients that underwent surgery in the appendicular skeleton for thyroid carcinoma bone metastasis from 1988 to 2011. Results. Overall patient survival probability by Kaplan-Meier analysis after surgery for bone metastasis was 72% at 1 year, 29% at 5 years, and 20% at 8 years. Patients who had their tumor excised (P = 0.001) or presented with solitary bone involvement had a lower risk of death following surgery adjusting for age and gender. Disease progression at the surgery site occurred more frequently with a histological diagnosis of follicular carcinoma compared with other subtypes (P = 0.023). Multivariate analysis showed that tumor subtype, chemotherapy, and preoperative radiation treatment had no effect on survival after surgery. Patients treated with radioactive iodine had better survival following thyroidectomy, but not following surgery for bone metastases. Conclusions. For patients undergoing surgery for thyroid cancer bone metastasis, resection of the bone metastasis, if possible, has a survival benefit.
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Lung metastases in patients with differentiated thyroid carcinoma and evaluation of response to radioiodine therapy. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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