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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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Id El Haj N, Hafidi S, Karam R, Boubia S, Karkouri M, Ridai M. Sternal metastasis as first manifestation of a papillary thyroid carcinoma: A case report. Int J Surg Case Rep 2021; 80:105663. [PMID: 33640638 PMCID: PMC7921493 DOI: 10.1016/j.ijscr.2021.105663] [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: 01/09/2021] [Revised: 02/13/2021] [Accepted: 02/13/2021] [Indexed: 11/15/2022] Open
Abstract
Sternal metastases of thyroid carcinoma are rare. There is no consensus for its management. Radical resection offers patients an optimal probability of long-term survival and improves the quality of life.
Introduction Papillary thyroid carcinomas (PTC) are differentiated forms of thyroid carcinoma. Sternal metastases from differentiated thyroid cancers (DTCs) are rare and are of particular prognostic interest. Radioiodine therapy has traditionally been the treatment of choice for metastases from differentiated thyroid cancers; however, bone metastases are known to be resistant to this form of treatment. Surgical resection of distant metastases from DTCs offers a better chance of achieving long survival and a better quality of life. We report the case of a 59-year-old women who presented a presternal mass for one year revealing metastatic papillary thyroid carcinoma, a total thyroidectomy with lymph node dissection and reconstruction of the sternal defect were performed. Overall, we demonstrate that radical resection of sternal metastases can be performed safely even in patients with poor prognosis to achieve palliation and potentiation of Radioiodine therapy. Case report This is a 59-year-old women referred by the endocrinology service for a sternal metastasis of a papillary thyroid carcinoma, who presented a painless, firm and fixed presternal mass for one year, a total thyroidectomy with lymph node dissection was performed with En-bloc resection and reconstruction as a one-stage procedure. Reconstruction of the chest wall was obtained by the rigid reconstruction with titanium bars and coverage with polymesh dual prosthesis, followed by radioiodine therapy and substitution with L-thyroxine. The patient is currently in good health condition, and does not present any complications and was in euthyroidism under substitution for the long term follow up. Discussion Thyroid cancer is the fastest increasing cancer in the United States, It is expected to replace colon cancer as the fourth leading cancer by 2030.2 More than 90% of thyroid carcinoma cases are classified as papillary or follicular carcinoma, both referred to as differentiated thyroid carcinomas (DTCs) and are associated with a 97%–98% 10-year survival rate. However, this rate can decrease to 14%–21% when patients present with bone metastases. Bone metastases have been reported to occur in 2%–13% of patients with DTC (Osorio et al. [1]). Several techniques have been used to repair after wide sternal resection for metastatic malignancies. Furthermore, choice of the reconstruction techniques depends on the size and the site of the defect and the preference of the surgeon (Lequaglie et al. [2]). Conclusion Sternal metastases from papillary thyroid carcinomas are rare,few cases of sternal metastasis as first presentation of a well-differentiated PTC are described in the literature. Operative management of these metastases is still controversial, but radical resection offer patients an optimal probability of long-term survival.
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Affiliation(s)
- Najat Id El Haj
- Department of Thoracic Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco; Hassan 2 University of Casablanca, Morocco.
| | - Sara Hafidi
- Department of Thoracic Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco; Hassan 2 University of Casablanca, Morocco.
| | - Rajaa Karam
- Department of Anatomopathology, Ibn Rochd-Casablanca University Hospital Center, Morocco; Hassan 2 University of Casablanca, Morocco.
| | - Souheil Boubia
- Department of Thoracic Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco; Hassan 2 University of Casablanca, Morocco.
| | - Mehdi Karkouri
- Department of Anatomopathology, Ibn Rochd-Casablanca University Hospital Center, Morocco; Hassan 2 University of Casablanca, Morocco.
| | - Mohammed Ridai
- Department of Thoracic Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco; Hassan 2 University of Casablanca, Morocco.
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Chaudhry IUH, Cheema A, Aqeel C, Al Haji Z, Alqahtani YA, Abbas A. Radical resection and improvised manubriosternal reconstruction technique for solitary manubriosternal metastasis from papillary thyroid cancer. Int J Surg Case Rep 2020; 76:278-281. [PMID: 33059205 PMCID: PMC7566078 DOI: 10.1016/j.ijscr.2020.09.201] [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: 09/16/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Thyroid papillary carcinoma rarely present as manubriosternum metastasis. The standard treatment for patients with metastatic disease is iodine ablation therapy. A surgical resection is a good option for patients with resectable limited bony metastasis. CASE PRESENTATION We report a case of a 50-year-old female with thyroid gland enlargement. Positron emission tomography scan (PET) showed a solitary manubriosternal metastasis. The patient underwent total thyroidectomy and claviculo-manubriosternal en-bloc resection and improvised reconstruction using Methyl methacrylate marlex mesh plate (MMS). Post-operative recovery was uneventful, and the patient received adjuvant radioactive iodine (RAI) treatment. At five year follow up patient remained disease-free. CONCLUSION In conclusion, we report a case of papillary carcinoma of thyroid with solitary manubriosternal metastasis treated with total thyroidectomy and radical en-bloc resection of clavicular heads, manubriosternal and reconstruction by our modified reconstruction technique, which provides the best MMS plate stability, cosmoses, and good disease-free survival. In solitary bony metastasis for thyroid cancer, radical resection followed by a RAI ablation, is the best treatment modality.
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Affiliation(s)
- Ikram Ul Haq Chaudhry
- Department of Thoracic Surgery and Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Ahsan Cheema
- Department of Thoracic Surgery and Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Chaudhry Aqeel
- Department of Thoracic Surgery and Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Zahra Al Haji
- Department of Thoracic Surgery and Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Yousif A Alqahtani
- Department of Thoracic Surgery and Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ahmad Abbas
- Department of Thoracic Surgery and Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Kim HJ, Youn I. Metastasis of Poorly Differentiated Thyroid Carcinoma to the Sternum: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:939-944. [PMID: 36238172 PMCID: PMC9432198 DOI: 10.3348/jksr.2020.81.4.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/03/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022]
Abstract
저분화 갑상선암의 복장뼈로의 전이는 드물어 산발적인 증례 보고가 대부분이다. 저자들은 저분화 갑상선암으로 우측 갑상선편측절제술을 시행 받은 83세 여자 환자에서 수술 2년 후 복장뼈로의 전이가 발생하여 복장뼈제거술 및 재건술을 시행 받은 드문 증례를 경험하였기에 이를 보고하고자 한다.
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Affiliation(s)
- Hae-Jung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Delliturri A, Pearl J, Zahir I, Weiss MH, Wiesel O. Follicular Thyroid Carcinoma Presenting as a Manubrium Mass. JAMA Otolaryngol Head Neck Surg 2019; 145:581-583. [PMID: 30973599 DOI: 10.1001/jamaoto.2019.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Antony Delliturri
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Joshua Pearl
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ismail Zahir
- Department of Pathology, Maimonides Medical Center, Brooklyn, New York
| | - Michael H Weiss
- Department of Otolaryngology, Maimonides Medical Center, Brooklyn, New York
| | - Ory Wiesel
- Division of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York
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Sternal metastasis as first presentation of a well-differentiated papillary thyroid carcinoma. Surgery 2017; 162:1336-1337. [PMID: 28237641 DOI: 10.1016/j.surg.2017.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 11/22/2022]
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Sabih Q, Spafford MF, Dietl CA. Poorly differentiated thyroid carcinoma with sternal invasion. A case report and review of the literature. Int J Surg Case Rep 2014; 5:816-20. [PMID: 25308189 PMCID: PMC4245677 DOI: 10.1016/j.ijscr.2014.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022] Open
Abstract
Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction have been reported. We report a 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion who underwent total thyroidectomy and partial sternal resection and chest wall reconstruction. In previous case reports the sternal tumor was not in continuity with the thyroid tumor. Despite developing an early local recurrence, there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively.
INTRODUCTION Surgical resection of poorly differentiated thyroid carcinoma with direct invasion of the sternum has not been previously reported. Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction for sternal metastases have been published. PRESENTATION OF CASE A 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion underwent total thyroidectomy and resection of the manubrium and both clavicular heads, and chest wall reconstruction with polypropylene mesh and bilateral myocutaneous pectoralis major muscle flaps. Postoperatively, the patient received radioactive iodine ablation. She developed a local recurrence, requiring additional ablation with radioactive iodine and external beam radiation therapy. Although there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively, a possible local recurrence was discovered 4 months later. DISCUSSION In previous case reports the sternal metastases were not in continuity with the thyroid tumor. In our patient, however, there was evidence of direct extension between the thyroid tumor and the sternal mass that were connected together with cords of tumor. CONCLUSION In our patient with poorly differentiated thyroid carcinoma invading the sternum, total thyroidectomy and resection of the manubrium with sternal reconstruction, combined with adjuvant radioactive iodine ablation and external beam radiation therapy was associated with prolonged survival after 5 years despite a small local recurrence.
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Affiliation(s)
- Quaratulain Sabih
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Michael F Spafford
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Charles A Dietl
- Division of Cardiothoracic Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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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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Chen YC, Tan NC, Lu HI, Huang SC, Chou FF, Kuo YR. Wide composite resection of follicular thyroid carcinoma with metastases to sternum: Report of two cases. Asian J Surg 2013; 36:130-3. [PMID: 23810164 DOI: 10.1016/j.asjsur.2012.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 02/04/2012] [Accepted: 05/01/2012] [Indexed: 11/26/2022] Open
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Two cases of sternectomy for bone metastasis due to aggressive variants of thyroid papillary carcinoma. Int J Surg Case Rep 2013; 4:156-9. [PMID: 23276755 DOI: 10.1016/j.ijscr.2012.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/22/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There are only few cases reported about the role of surgery in the presence of single or multiple bulky bone metastases. The literature about treatment for bulky sternal metastases is scarce. PRESENTATION OF CASE We present two patients treated surgically for metastatic thyroid lesions. Case 1 is a female with tumor of the thyroid right lobe, mediastinal extension and multiple pulmonary metastases. Bony infiltration was observed in the sternum and ribs. Case 2 is a female with a lesion in the cervical region of the thyroid left lobe and increase in volume on the upper sternal manubrium. DISCUSSION Patients with well-differentiated thyroid cancer may present with extracervical metastasis in 5-10% of cases at diagnosis. Bone metastases occur in 0.4% of cases of papillary carcinoma. Management remains controversial. There are only isolated cases reported in the literature of the role surgery plays in the presence of single or multiple bulky bone metastases. The basis for initial surgical approach is keeping in mind that the surgical procedure is palliative in order to achieve optimal hypothetical ablation as a result of reduced tumor volume. CONCLUSION Surgery is the elective treatment and can be performed safely and with adequate results, allowing proper optimization of the dose of (131)I for ablative therapy.
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