Surgical management of metastases to the thyroid gland

Colorectal cancer metastasis to the thyroid: A case report and review of the literature

Metastatic thyroid cancer is rare. Here, the case of a patient with colon cancer that metastasized to the thyroid is described. The patient underwent radical rectal cancer surgery in August 2017 and received six cycles of chemotherapy with oxaliplatin and capecitabine postoperatively. On August 4, 2018, the patient was admitted to the hospital due to the discovery of thyroid nodules on ultrasound and carcinoembryonic antigen levels within the normal range. The biopsy from the fine needle aspiration suggested a malignant tumor. The patient underwent radical thyroid cancer surgery. Using intraoperative rapid frozen pathology, medullary carcinoma was diagnosed. Using postoperative routine pathology combined with immunohistochemistry results, thyroid metastasis from colorectal adenocarcinoma was diagnosed. After surgery, the patient regularly visited the outpatient clinic for chemotherapy with capecitabine. As of May 2023, the patient is still alive with no recurrence.

A Rare Case of Thyroid Metastasis From Colorectal Cancer: Diagnostic and Therapeutic Challenges

The incidence of thyroid metastases among patients suffering from primary colorectal cancer is rare, and only a few cases have been described in the literature. As these metastases are usually asymptomatic, they most frequently present as incidentalomas on follow-up imaging. Hereby, we present and discuss an interesting case of metastatic sigmoid adenocarcinoma of the thyroid gland, diagnosed and treated at our institution.

Locally sourced: site-specific immune barriers to metastasis

Tumour cells migrate very early from primary sites to distant sites, and yet metastases often take years to manifest themselves clinically or never even surface within a patient's lifetime. This pause in cancer progression emphasizes the existence of barriers that constrain the growth of disseminated tumour cells (DTCs) at distant sites. Although the nature of these barriers to metastasis might include DTC-intrinsic traits, recent studies have established that the local microenvironment also controls the formation of metastases. In this Perspective, I discuss how site-specific differences of the immune system might be a major selective growth restraint on DTCs, and argue that harnessing tissue immunity will be essential for the next stage in immunotherapy development that reliably prevents the establishment of metastases.

Updates from Our Institutional Experience with Thyroid Nodules Diagnosed as Metastases

BACKGROUND

Thyroid metastases (TMs) are a rare entity, ranging between 0 and 24% in the autopsy series. In the assessment of the best management, the discrimination between a primary and a metastatic thyroid lesion is crucial. In this regard, fine needle aspiration cytology (FNAC) is likely to play a crucial role especially when ancillary techniques (i.e., immunocytochemistry (ICC) and molecular testing) are carried out.

METHODS

We searched for all the TMs diagnosed using FNAC and analyzed between 2014 and 2023. The cases were processed with liquid-based (LBC) and ICC and molecular testing performed on LBC-stored material.

RESULTS

We reported 2.2% (19 cases) of TMs out of 1022 malignancies. TMs included: 1 larynx carcinoma (LX-Ca), 1 melanoma, 2 breast carcinomas (B-Ca), 3 lung carcinomas (LG-Ca), 4 gastro-intestinal carcinomas (GI-Ca), and 8 clear cell renal carcinomas (CCRC). All patients had a previous cancer history, between 300 and 2 months from the primary cancers. The morphological features were supported by ICC, which were contributive in 100% of cases. All TMs cases were characterized by multiple thyroid nodules except the melanoma case. Four cases underwent total thyroidectomy (1 B, 1 LX, 1 melanoma, and 1 CCRC) whilst 15 TMs were treated with radio-chemotherapy.

CONCLUSIONS

FNAC empowered the diagnostic workup of patients with TMs avoiding useless surgery. The low sensitivity of cytology might be reinforced by the application of ancillary techniques. We found a predominant rate of kidney metastatic carcinomas, followed by lung and breast. TMs are frequently multifocal and in a context of a systemic disease so a tailored therapy seems to be the best treatment.

Recurrent Metastatic Colorectal Adenocarcinoma to the Thyroid Gland Presenting With Vocal Cord Paralysis and Inspiratory Stridor

The most common sites for metastases of colorectal cancer include the liver, lungs, brain, and regional lymph nodes. However, a limited number of reported cases describe colon cancer metastasis to the thyroid gland. Metastatic colorectal adenocarcinoma to the thyroid gland is rare. The majority of these cases with colon cancer metastases to the thyroid gland are diagnosed years after initial treatment of colon cancer. The discovery is usually made after routine surveillance imaging, and often patients have minimal or absent symptoms. We report a case of a recurrence of metastatic colorectal adenocarcinoma to the thyroid gland presenting with vocal cord paralysis and inspiratory stridor.

Adenocarcinoma Metastasis from Colon to the Thyroid

Background

Colorectal cancer metastasis to the thyroid is extremely rare and happens in the late course of the disease. Case Description. Here is the report of a 55-year-old female patient who came to us with the chief complaint of cough, diagnosed with colon metastasize to the lung. Surgical resection of the mass was performed. However, a thyroid mass was found incidentally in her postoperative follow-up. Fine needle aspiration of thyroid mass showed papillary thyroid carcinoma. But, after thyroidectomy, the origin of the mass was reported to be adenocarcinoma metastasis from colon cancer.

Conclusion

Although thyroid metastasis from colorectal cancer rarely occurs, it should be considered in a patient with a solitary thyroid nodule and a past medical history of colon cancer. Surgical treatment is the preferred choice of treatment in these cases.

Metastases to the thyroid gland: ultrasonographic findings and diagnostic value of fine-needle aspiration cytology

Introduction

In the present study, we aimed to analyze ultrasonographic findings of metastases to the thyroid and explore the role of fine-needle aspiration cytology (FNAC) in the diagnosis of metastases to the thyroid.

Methods

Twelve cases of cytologically or/and pathologically confirmed metastatic tumors of the thyroid gland were reviewed. All the primary thyroid lesions and lymphomas were excluded. The location, maximum size, echogenicity, shape, margin, presence of calcifications, vascularity, and cervical lymph nodes were assessed on ultrasonography. In addition, the results of cytology or pathology (or both) were noted retrospectively.

Results

Eight of 10 patients were diagnosed correctly with FNAC. Two cases presented with diffuse involvement in both thyroid lobes. Nine cases demonstrated a hypoechoic nodule with an irregular margin, four of which had microcalcifications. One case presented with a mixed solid and cystic mass with an oval shape. The lesions with cervical lymph nodes were found in seven cases.

Conclusion

Most metastatic thyroid cancer has similar ultrasound features to primary thyroid cancer. In some cases with atypical US features, ultrasound diagnosis should be combined with the medical history. FNAC might be helpful in the diagnosis.

Metastatic Thyroid Osteosarcoma With Concomitant Multifocal Papillary Carcinoma Presenting as a Collision Tumor

Metastatic involvement of the thyroid occurs rarely, by either hematogenous spread or direct extension from adjacent organs. The most frequent metastatic tumors are clear cell, renal cell, lung, breast, and squamous cell carcinoma.

The occurrence of osteosarcoma and papillary thyroid carcinoma in the same patient is rare, with only a few reported cases in the literature. On the other hand, only one case of osteosarcoma thyroid metastasis has so far been reported.

We herewith present another case with metastatic osteosarcoma and multifocal papillary thyroid carcinoma presenting as a collision tumor and review the relevant literature.

Solitary thyroid metastasis from colorectal cancer: Case report

INTRODUCTION AND IMPORTANCE

Thyroid metastasis of colorectal cancer is rare and the patient with thyroid metastasis has no symptoms early in the disease course. On the other hand, evaluation of thyroid is not generally included in the routine follow-up of colorectal cancer. Therefore, the diagnosis of thyroid metastasis of colorectal cancer may be delayed.

PRESENTATION OF CASE

Chest computed tomography revealed a nodule on the right lobe of the thyroid in 53-year-old woman diagnosed with sigmoid colon adenocarcinoma. This nodule was identified having as increased metabolic activity by 18F-fluorodeoxyglucose positron emission tomography-computed tomography and confirmed to be consisted of cystic and solid portions by ultrasonography. Fine needle aspiration cytology of the nodule revealed metastasis of colon cancer. The patient underwent laparoscopic anterior resection and a total thyroidectomy. The size of the thyroid tumor was 1.2 cm with free resection margin.

DISCUSSION

The clinical features of thyroid metastasis from colorectal cancer are not typical. In addition, follow-up examinations of patients with colorectal cancer do not include imaging studies of the neck, so the diagnosis of thyroid metastases is delayed. The management strategies for thyroid metastasis from colorectal cancer include a total thyroidectomy without prophylactic neck lymph node dissection and chemotherapy. However, as the penetration of chemotherapeutic drugs into the thyroid is difficult, the effect on the thyroid is considered insignificant.

CONCLUSION

Surgical treatment should be considered for treatment of thyroid metastasis.

Colorectal cancer metastases to the thyroid gland-a systematic review : Colorectal cancer thyroid metastases

BACKGROUND

Despite its rich vasculature, the thyroid gland is a rare site of metastatic disease. We present a systematic review of colorectal cancer (CRC) thyroid metastases, with emphasis on diagnosis, therapeutic management, and oncological outcomes.

METHODS

A systematic review of the English literature (1990 to 2019) was performed, using the PubMed, Embase, and Google Scholar bibliographic databases. For each patient, epidemiological, surgical, histopathological, and oncological data were extracted.

RESULTS

A total of 111 patients (40% males, mean age 61 ± 12 years) were included in the final analysis. The primary CRC was locally advanced (T3-T4) in 83%, had positive lymph nodes (N+) in 65%, and had distant metastases (M+) in 28%. Thyroid metastases were synchronous in 15% and metachronous in 80%, with a mean interval of 51 ± 31 months from primary tumor treatment. Thyroid metastatic disease was diagnosed clinically (60%), radiologically (33%), biochemically (2%), or postmortem (5%). When performed, FNA biopsy was diagnostic in 73% and highly suspicious in 13%. A total of 63% of patients had additional distant metastases, usually in the liver or lungs, while 68% of patients underwent surgical excision (total or subtotal thyroidectomy 58%, lobectomy 42%) and 43% received adjuvant chemotherapy or radiotherapy. Mean overall survival after primary CRC was 55.5 ± 34.7 months, with mean disease-free survival of 31.3 ± 27.2 months. Following diagnosis or treatment of thyroid metastases, 1-, 2- and 3-year survival rates were 79, 66, and 60%, respectively. Mean survival following diagnosis of thyroid metastases was 11.3 months.

CONCLUSIONS

CRC thyroid metastasis is a relatively uncommon event, usually associated with locoregionally advanced tumors. Prognosis is poor, mainly due to multimetastatic disease.

Metastasis to the thyroid gland: Characterization and survival of an institutional series spanning 28 years

INTRODUCTION

Secondary neoplasms in the thyroid are rare. The study aim was to provide an overview of non-thyroid tumours that metastasize to the thyroid through our institutional experience.

MATERIALS AND METHODS

This study entailed a review of the pathology database searching for patients with metastasis to the thyroid at the Karolinska University Hospital between 1992 and 2019 and review of their medical files.

RESULTS

Out of 1939 surgical procedures with a histopathological diagnosis of a thyroid malignancy, 31 cases (1.6%, 65% females) with a diagnosis of metastatic epithelial neoplasms to the thyroid gland were identified. The median age at discovery of the thyroid metastasis was 68 years (range 48-85). The most common primary tumours were clear cell renal cell carcinoma (ccRCC) (36%), followed by non-small cell lung cancer (19%), oesophageal cancer (16%), head and neck malignancies (16%), malignant melanoma (10%) and unknown primary tumour (3%). The median time from the diagnosis of the primary tumour to diagnosis of the thyroid metastasis was 20 months (0-232) and was longest for patients with ccRCC (median 107 months). At 12 months after the non-thyroid metastasis diagnosis 48% had died. The longest survival was observed in ccRCC and the shortest in lung cancer. Surgical management of the metastasis was associated with improved survival (25 vs 3.8 months, p = 0.001).

CONCLUSIONS

Non-thyroid metastases to the thyroid were rare but should be suspected in patients with previous history of non-thyroid malignancy and a thyroid nodule. Prognosis was poor, but surgical management was beneficial in selected patients.

Thyroid gland metastasis from renal cell carcinoma: a case series and literature review

BACKGROUND

Renal cell carcinoma (RCC) is the most common malignancy that metastasises to the thyroid. This study aims to better understand the clinical characteristics of patients with thyroid metastasis from RCC.

METHODS

A retrospective case series of patients with thyroid metastasis from RCC between 2008 and 2020 from two tertiary centres were examined. MEDLINE and PubMed database searches were performed to retrieve the relevant literature.

RESULTS

Fifteen patients (eight males) were identified, with a median age of 57.0 (interquartile range (IQR) 51.0-63.0) at time of RCC diagnosis. Median time to thyroid metastasis was 92.0 months (IQR 40.0-156.0), with 12 (80.0%) patients undergoing thyroidectomy within 2 months of diagnosis. No patients developed post-operative complications or local thyroid recurrence. The two most common non-thyroid metastatic sites in this case series are lungs and bone (five patients, respectively; 33.3%) and pancreas (four patients; 26.7%). Ten (66.6%) patients underwent systemic chemotherapy, and five (33.4%) patients underwent radiotherapy for other sites of metastasis. Median survival following thyroid metastasis was 54.0 months (IQR 15.0-100.0). The literature review was conducted through MEDLINE and PubMed database searches, and 30 papers were considered relevant to this review. Results from our study are comparable to those reported in the literature.

CONCLUSION

Thyroid metastases can occur long after nephrectomy and portends a better prognosis. To prevent development of central neck disease, thyroidectomy should be considered.

When a House Is Not a Home: A Survey of Antimetastatic Niches and Potential Mechanisms of Disseminated Tumor Cell Suppression

Over the last four decades, the cancer biology field has concentrated on cellular and microenvironmental drivers of metastasis. Despite this focus, mortality rates upon diagnosis of metastatic disease remain essentially unchanged. Would a small change in perspective help? Knowing what constitutes an inhospitable, rather than hospitable, microenvironment could provide the inspiration necessary to develop better therapies and preventative strategies. In this review, we canvas the literature for hints about what characteristics four common antimetastatic niches-skeletal muscle, spleen, thyroid, and yellow bone marrow-have in common. We posit that thorough molecular and mechanistic characterization of antimetastatic tissues may inspire reimagined therapies that inhibit metastatic development and/or progression in an enduring manner.

Metastasis of esophageal squamous cell carcinoma to the thyroid gland with widespread nodal involvement: A case report

BACKGROUND

Esophageal cancer is one of the most common causes of cancer-related death. Some patients with esophageal cancer have distant metastases at the time of diagnosis, but metastasis to the thyroid gland (MTG) and multifocal thyroid lesions alone are extremely rare.

CASE SUMMARY

In this case report, we present a case of a 69-year-old male with esophageal MTG. The patient visited our hospital for a routine body check-up, which revealed multifocal nodules in his thyroid lobes and enlarged cervical lymph nodes. A fine needle aspiration biopsy showed malignancies in both thyroid lesions and lymph nodes. The patient was initially diagnosed with primary bilateral thyroid cancer that spread to his lymph nodes, and a total thyroidectomy was performed. The histology showed MTG and therefore, a diagnostic work-up was implemented to determine the primary tumor. A fluorine-18-deoxyglucose positron emission tomography scan showed that the lower part of the esophagus and the lymph nodes in the neck, chest, and abdomen were involved. An esophagogastroscopy and corresponding pathology revealed distal esophageal squamous cell carcinoma. The esophageal MTG diagnosis was confirmed with pathological immunohistochemistry.

CONCLUSION

This case report highlights the difficulty in diagnosing esophageal MTG. Patients may have no malignancy history and be asymptomatic. Further diagnostic procedures are necessary after MTG is confirmed by cytology or histology, and the final diagnosis should be made according to the identification of the primary malignancy combined with pathological immunohistochemistry findings.

Characteristics of clear cell renal cell carcinoma metastases to the thyroid gland: A systematic review

BACKGROUND

Thyroid gland is an uncommon site for metastases from clear cell renal cell carcinoma (CCRCC) and literature is scarce. Due to the variable and often long lag time before development of metastases in patients with CCRCC, thyroid nodules may be misdiagnosed initially as benign. This systematic review aims at a better understanding of the nature of these metastases.

METHODS

A bibliographic search was performed using PubMed (1990-2019), key words being “renal cell carcinoma, thyroid, kidney cancer, clear cell.” 147 cases were analyzed. The patient’s characteristics assessed were: age, sex, stage, size of metastases, lag time, diagnostic modality, initial symptoms, treatment and outcome in last documented follow up. Binary logistic regression, Spearman’s rho and ANOVA were used to identify differences between the existing variables.

RESULTS

The mean age (± SD) was 64 ± (10) years in males and 64 (± 11) in females. The mean lag time to diagnosis of thyroid metastases was 8.7 (± 6.3) years. Gender distribution of the patients was 46.3% male, 52.4% female. There was a weak correlation between lag time and size of metastases, not statistically significant. Size of metastases was significantly higher in symptomatic patients (6.06 ± 3.51 cm) compared to those with painless mass (4.6 ± 0.29 cm) and asymptomatic ones (3.93 ± 1.99 cm) (P = 0.03). Fine Needle Aspiration was diagnostic in 29.4% of cases, 47.1% were non diagnostic. Most patients (80.3%) underwent thyroid surgery. At 1 year follow up, 55.6% of patients operated were alive versus 35.3% who did not have surgery, though this was not statistically significant (P = 0.1).

CONCLUSION

A larger size of thyroid metastasis was more likely to present with symptomatology. A high index of suspicion is warranted when evaluating thyroid nodules in CCRCC patients. There was no significant difference in outcome between patients who underwent surgery and those who did not. With the wider use of immune check-point inhibitors and tyrosine kinase inhibitors in metastatic CCRCC, surgery may eventually be reserved only for palliative purposes.

Metastases to the Thyroid: Potential Cytologic Mimics of Primary Thyroid Neoplasms

Secondary tumors of the thyroid gland, although uncommon, can sometimes pose as diagnostic dilemmas on fine-needle aspiration cytology, frequently mimicking primary thyroid neoplasms. An accurate diagnosis of such lesions, however, is critical for patient management and prognosis. The present study reviews the cytologic aspects of secondary involvement of the thyroid, listing the most common primary malignancies that metastasize to this gland. Knowledge of such morphologic aspects, combined with prompt clinical correlation, is essential for the cytopathologist to achieve a proper, definite diagnosis.

Metastases to the thyroid gland from renal cancer

Aims and background

Metastases to the thyroid gland from renal cancer pose a challenge to physicians, due in part to the rarity of the phenomenon, the prolonged time interval between removal of the primary renal cancer and the appearance of metastases, the difficulty in diagnosis, and the uncertainty regarding long-term prognosis. We report our experience with diagnosis and management of patients affected by thyroid metastases from renal clear cell carcinoma.

Study design

We report herein three clinical cases of thyroid metastases from renal clear cell carcinoma. We also present a review of the literature and examine common features of clinical presentation and management recommendations.

Results

Over the past 17 years, 918 patients underewent surgery for thyroid cancer in our institution. Histological examination demonstrated a thyroid secondary malignancy from kidney cancer in 3 cases. Two patients underwent total thyroidectomy, whereas in the third patient a palliative right lobectomy with homolateral latero-cervical lymphoadenectomy was performed. At a 5-year follow-up, only one patient survived and was disease-free.

Conclusions

Thyroid metastases from renal clear cell carcinoma are a rare occurrence but should be taken into consideration in the differential diagnosis of a thyroid nodule. Preoperative diagnosis is often difficult. Nevertheless, an extensive diagnostic workup is recommended because the subsequent therapy must be tailored on the basis of the local extension of metastases. Surgical treatment of solitary thyroid metastases is recommended. However, patients with disseminated disease have a poor prognosis, and palliative care is the indicated recommendation. In these patients and in surgically untreatable patients, prolonged survival may be achieved by adjuvant medical therapy.

Clinical Characteristics of Patients With Renal Cell Carcinoma and Metastasis to the Thyroid Gland

Introduction:

Renal cell carcinoma (RCC) is the most common malignancy to metastasize to the thyroid gland. The aims of this study are as follows: (1) to analyze the clinical characteristics of patients with thyroid involvement of RCC and (2) in patients with RCC thyroid metastasis, to determine whether RCC metastasis to glandular organs only portends a better prognosis compared with other patterns of RCC metastasis.

Methods:

Patients from Wake Forest Baptist Medical Center (WFBMC) diagnosed with thyroid metastasis from RCC were identified and medical records retrospectively examined. A systematic review of the literature for cases of RCC involving the thyroid gland was also performed. The clinical characteristics of the institutional cohort and the cases from the literature review were compared. Descriptive statistical analysis was performed, and overall survival (OS) was summarized using Kaplan-Meier methods.

Results:

The median OS for the WFBMC cohort was 56.4 months. In the literature review cohort, OS of patients with RCC thyroid metastasis was 213.6 months, and there was no statistically significant survival difference based on the site of metastasis. Median survival after thyroid metastasis from RCC for the WFBMC and literature cohort was 21.6 and 45.6 months, respectively.

Conclusions:

Metastatic RCC should be included in the differential of a new thyroid mass. Treatment directed at the thyroid metastasis results in prolonged survival in some cases. Further analysis into the genomic differences and mechanisms of thyroid metastasis is warranted.

Colon cancer metastasis to the thyroid gland: A case report

INTRODUCTION

Thyroid metastases from colorectal cancer are uncommon and few cases are described in literature.

CASE PRESENTATION

A 64-year-old female patient presented with an asymptomatic right cervical nodule with a rapid growth six years after sigmoidectomy for cancer and two years after resection of colorectal lung metastases. Increased CA 19.9 was identified and a thoracoabdominal CT scan revealed the onset of new metastatic bilateral pulmonary lesions. Neck ultrasonography showed a suspicious nodule in the right thyroid lobe, and Fine-needle Aspiration Cytology (FNAC) of the nodule lead to the diagnosis of colorectal cancer metastasis. A right thyroid lobectomy with right central lymph node dissection was performed. The patient underwent chemotherapy with response, but this was posteriorly suspended due to haematological side effects, and the disease spread.

DISCUSSION

Thyroid metastases from colorectal cancer are rare, but, with the improvement of radiologic exams and the higher survival rate of these patients, more cases are being described. The majority of the cases present pulmonary and hepatic metastases and the prognosis is poor. The decision to operate and the type of operation depend on the extent of the metastatic disease and the patient's overall condition.

CONCLUSION

A low threshold of suspicion is crucial to make a timely diagnosis of thyroid metastases from colorectal cancer. Treatment is controversial, but, without surgery, the need may arise for tracheostomy.

Metastatic neoplasms to the thyroid diagnosed by fine-needle aspiration/core needle biopsy: Clinicopathologic and cytomorphologic correlation

BACKGROUND

Although thyroid fine-needle aspiration (FNA) and core needle biopsy (CNB) are commonly utilized modalities in the evaluation of thyroid nodules, metastatic tumors to the thyroid are only rarely encountered. We aspired to determine the incidence and primary origin of metastases to the thyroid at our institution and to examine their clinicopathologic and cytomorphologic features.

MATERIALS AND METHODS

A search of our database was undertaken to review all thyroid FNA and/or CNB examined between January 2004 and December 2013.

RESULTS

During our 10 year study period, 7497 patients underwent 13,182 FNA and/or CNB. Four hundred sixty one (6%) patients were diagnosed with neoplasms. Only five (1.1%) were found to have metastatic tumors to the thyroid involving three females and two males. Two were diagnosed by FNA, one by CNB, and two by both FNA and CNB, with rapid on-site evaluation (ROSE) employed in all cases. The primary malignancies in the five cases were pulmonary and nasopharyngeal squamous cell carcinomas, renal cell carcinoma, pancreatic adenocarcinoma, and olfactory neuroblastoma. The cytomorphologic features of these metastases to the thyroid aided in their distinction from primary thyroid carcinoma. Two of these metastases, a renal cell carcinoma and pancreatic adenocarcinoma, were the first clinical manifestations of cancer.

CONCLUSION

Metastases to the thyroid diagnosed by FNA and/or CNB are exceedingly rare in our institution, comprising only 0.04% of total FNA/CNB and only 1.1% of all thyroid neoplasms. We report the first known case of metastatic olfactory neuroblastoma to the thyroid diagnosed by aspiration cytology. In addition, an occult primary may present as a thyroid mass on FNA or CNB as occurred with two of our cases. FNA/CNB proved to be highly effective in the diagnosis of metastases to the thyroid, with ROSE proving valuable in assuring specimen adequacy. Thyroid FNA and CNB demonstrated great utility in the setting of metastatic disease, obviating the need for more invasive procedures.

Thyroid Gland Metastasis from Cancer of the Uterine Cervix: An Extremely Rare Case Report

The thyroid gland is a relatively uncommon site for a metastatic disease, although it is richly supplied with blood. The metastases may originate from various primary sites, mainly kidney, lung, head and neck, and breast. Thyroid metastasis from cervical carcinomas is extremely rare; and only a few cases have been previously reported in the literature. In patient with thyroid nodules and an oncological history, the possibility of thyroid metastasis should be seriously considered. Despite the rarity of the metastasis of cervical carcinoma to the thyroid, it is difficult to say appropriate treatment approach for these lesions. When managing such patients, decision-making should balance the possibility of gaining long-term survival against estimation of the aggressiveness of the disease and its possible complications. Here, a case of thyroid metastasis from a squamous cell carcinoma of the uterine cervix presenting with cervical mass and difficulty in swallowing and its treatment is reported.

Malignant melanoma with synchronous thyroid metastases: case report and literature review

Thyroid metastases are rare in clinical practice. We describe the case of an 85-year-old woman who was referred to our department due to a multinodular goiter with compressive symptoms and subclinical hyperthyroidism. The patient was also undergoing evaluation for a polyp in her left nasal cavity, which was then diagnosed as a malignant melanoma of the nasal mucosa. A thoracoabdominal magnetic resonance imaging obtained for cancer staging revealed a > 50% tracheal obstruction caused by the goiter. The patient underwent simultaneous total thyroidectomy and melanoma excision. Histological analysis of the thyroid showed the presence of multiple metastatic foci from the melanoma. Due to the patient's age, a decision was made to maintain her under surveillance and administer palliative treatment if necessary. Although metastases to the thyroid are rare, they should be considered in the differential diagnosis of thyroid lesions in patients with a known primary tumor. The thyroidectomy, performed in this patient's case, allowed the diagnosis of the metastases and relief of compressive symptoms caused by the goiter.

Primary Squamous Cell Carcinoma of Thyroid - A Rare Malignant Goitre

Primary squamous cell carcinoma of thyroid is a very rare malignant disease because thyroid gland lacks squamous cells. The disease is almost fatal. Only around 60 cases have been reported in literature. Its incidence is less than 1 % of all thyroid malignancies. The overall survival rate is less than 1 year after the diagnosis. Here we report a rare case of a 70 year old lady who presented with sudden increase in the size of swelling associated with pain and obstructive symptoms in long standing thyroid swelling. Considering patient's age and inoperable nature of disease we treated the patient with concurrent chemoradiation.

Metastasis to the Thyroid Gland: A Critical Review

Background

Metastasis to the thyroid gland from nonthyroid sites is an uncommon clinical presentation in surgical practice. The aim of this review was to assess its incidence management and outcomes.

Methods

A literature review was performed to identify reports of metastases to the thyroid gland. Both clinical and autopsy series were included.

Results

Metastases to the gland may be discovered at the time of diagnosis of the primary tumor, after preoperative investigation of a neck mass, or on histologic examination of a thyroidectomy specimen. The most common primary tumors in autopsy studies are from the lung. In clinical series, renal cell carcinoma is most common. For patients with widespread metastases in the setting of an aggressive malignancy, surgery is rarely indicated. However, when patients present with an isolated metastasis diagnosed during follow-up of indolent disease, surgery may achieve control of the central neck and even long-term cure. Other prognosticators include features of the primary tumor, time interval between initial diagnosis and metastasis, and extrathyroid extent of disease.

Conclusions

In patients with thyroid metastases, communication among clinicians treating the thyroid and the index primary tumor is essential. The setting is complex, and decisions must be made considering the features of the primary tumor, overall burden of metastases, and comorbidities. Careful balancing of these factors influences individualized approaches.

Metastasis of colon cancer to the thyroid and cervical lymph nodes: a case report

The incidence of thyroid metastasis among colorectal cancer patients is extremely rare. We report a case of colonic adenocarcinoma metastasis to the thyroid gland with treatment of lung and liver metastases, in a 61-year-old woman with a history of colon cancer. She showed a thyroid mass related to a 3-month history of hoarseness. Physical and imaging examinations disclosed a diffuse large thyroid mass with swollen cervical lymph nodes. Fine-needle aspiration cytology of the thyroid mass suggested malignancy. The patient underwent total thyroidectomy. Histopathological examination and immunohistochemical staining revealed adenocarcinoma, which was consistent with a diagnosis of metastases from primary colon cancer to the thyroid and cervical lymph nodes. At 2 years after thyroid surgery, the patient has been continuing outpatient chemotherapy for the lung and liver metastases. Thyroidectomy appeared to both relieve the patient and prevent local symptoms.

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology

OBJECTIVE

Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary care hospital.

SUBJECTS AND METHODS

We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available.

RESULTS

Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01).

CONCLUSIONS

Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates.

Diagnosis of Metastasis to the Thyroid Gland: Comparison of Core-Needle Biopsy and Fine-Needle Aspiration

OBJECTIVES

Early detection and diagnosis of metastasis to the thyroid gland is important. This study aims to evaluate the clinical value of core-needle biopsy (CNB) by comparing the results of CNB and fine-needle aspiration (FNA) in patients with clinically suspected metastasis to the thyroid gland.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary referral practice.

SUBJECTS

Fifty-two thyroid nodules from 52 patients with clinically suspected metastasis to the thyroid gland (mean age, 62.8 years).

METHODS

Of these 52 patients, FNA was initially used in 41 patients and CNB in 20 patients (11 patients as the initial approach and 9 patients after inconclusive FNA results). Ultrasound features of metastasis to the thyroid gland were evaluated. The diagnostic performance, repeated diagnostic examination rate, and diagnostic surgery rate were evaluated for FNA and CNB.

RESULTS

Among these 52 patients, 46 were diagnosed with thyroid metastases and 6 were diagnosed with primary thyroid cancer. Common ultrasound features were an ovoid to round shape (58.7%), ill-defined margin (56.5%), hypoechogenicity (65.2%), and no calcifications (87.0%). Core-needle biopsy achieved a significantly higher sensitivity than FNA (100.0% vs 58.6%, P = .008) without any false-negative results. Both the repeated diagnostic examination rate and the diagnostic surgery rate were significantly lower in CNB than in FNA (5.0% vs 46.3%, P = .001, and 5.0% vs 34.1%, P = .013, respectively).

CONCLUSIONS

In cases of known rare primary malignancy, nontypical ultrasound features of primary thyroid malignancy, and need for an additional immunohistochemical analysis, CNB may be primarily considered.

Survival after renal cell carcinoma metastasis to the thyroid: single center experience and systematic review of the literature

BACKGROUND

Renal cell carcinoma can metastasize to uncommon sites, for example, the thyroid gland where metastases are rarely found. To determine the patient survival and the time between cancer diagnosis and thyroid metastasis, we analyzed a large patient cohort from our hospital records and performed a systematic review.

PATIENTS AND METHODS

Patients diagnosed between 1978 and 2007 with thyroid metastases from renal cell carcinoma were retrospectively identified from the hospital database. A systematic literature search was performed for publications describing at least three cases of thyroid metastasis from renal cell carcinoma. Case data from the identified studies were collected and used to determine the survival data.

RESULTS

We identified 34 patients (19 females) from our hospital records with a mean age of 67 years (range, 33-79) when thyroid metastasis was diagnosed. Median time to primary metastasis after resection of renal cell carcinoma was 6.5 years (range, 0-25) with a single case of synchronous metastasis. Median survival after primary metastasis was 4.7 years (95% confidence interval [CI]: 1.8-7.6). The systematic review included 32 studies with 285 patients. Case data could be extracted for 202 patients. Median time to thyroid metastasis (without synchronous cases) was 8.8 years (95% CI: 7.5-10.1). Median actuarial survival after thyroid metastasis was 3.4 years (95% CI: 2.2-4.6). Total thyroidectomy was not associated with a better survival compared to partial thyroidectomies.

CONCLUSIONS

Time to thyroid metastasis of renal cell carcinoma can be very long, and survival after thyroidectomy is favorable compared to metastasis to other sites.

The role of thyroidectomy in metastatic disease to the thyroid gland

BACKGROUND

Whether thyroidectomy for metastases to the thyroid is associated with a survival benefit remains debatable; in general, palliation and disease control are accepted goals in this setting. We evaluated the clinical features and overall survival of patients with thyroid metastasis treated by thyroid resection or nonoperatively.

METHODS

This retrospective analysis included 90 patients identified with metastasis to the thyroid confirmed pathologically via thyroidectomy (n = 31) or fine-needle aspiration biopsy (n = 59). Overall survival was calculated by the Kaplan-Meier method, and differences between groups were calculated by Pearson's χ (2) coefficient.

RESULTS

The most common primary malignancies were renal cell (20%), head and neck (19%), and lung (18%). The median time from primary tumor diagnosis to thyroid metastasis diagnosis was 37.4 months (range 0-210 months). Most metastases (69%) were metachronous, and 12% were isolated. The median follow-up after diagnosis of thyroid metastasis was 11.5 months (range 0-112 months). Median overall survival was longer in thyroidectomy patients compared to the fine-needle aspiration group (34 vs. 11 months, P < 0.0001). Patients with renal cell primary tumors were more likely to undergo thyroidectomy than patients with other primary tumors (78 vs. 24%, P < 0.0001). Nearly all patients with lung primary tumors died within 24 months of thyroid metastasis diagnosis, and thyroidectomy was only offered to three patients.

CONCLUSIONS

Thyroidectomy was safe for selected patients with metastatic disease to the thyroid. Patients with metachronous or renal cell metastasis to the thyroid and whose primary tumor is/was treatable may be appropriate candidates for resection. Lung cancer metastasis to the thyroid is generally an ominous sign.

Thyroid metastasectomy

Metastases to the thyroid gland are uncommon. Renal, lung, breast, and colon cancer and melanoma are the most common primary diseases implicated. Few retrospective series have been reported. Treatment decisions must be individualized, and will depend on the state of systemic disease. Selected patients could benefit from surgical treatment. Although most patients selected for surgery will not be cured, the aim of surgery is to avoid the complications of uncontrolled central neck disease.

Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature

The thyroid gland is an uncommon site for metastatic disease but cases have been well-documented in the literature, particularly in autopsy series. A retrospective review of surgical pathology and autopsy pathology database for patients with metastatic carcinoma to the thyroid was performed at the University of Massachusetts Medical Center between January 1993 to January 2013. We identified a total of 10 patients with metastatic carcinoma to the thyroid; 6 were in surgical pathology specimens out of a total of 1,295 thyroid carcinoma (0.46 %) and 4 were diagnosed at autopsy out of a total of 2,117 (0.19 %) autopsy cases during this period. Cases with direct extension of the tumor into the thyroid from local primary sites such as larynx, esophagus or soft tissues of the neck were excluded. The primary tumors in these cases comprised of four lung carcinomas, three colorectal carcinomas, a renal cell carcinoma, a pleural malignant mesothelioma, and an unknown primary. Therefore, it is important to keep intrathyroidal metastases in the differential diagnosis when evaluating a thyroid nodule, particularly in patients with a previous history of malignancy. Furthermore, a literature review reveals over 1,400 cases have been previously reported, with the most common malignancies from the kidney (34 %), lung (15 %), gastrointestinal tract (14 %), and breast (14 %).

Metastatic renal cell carcinoma to the sinonasal cavity: a case series

Objectives To describe the presentation, work-up, and management of patients with metastatic renal cell carcinoma (RCC) to the sinonasal cavity and skull base, and to describe our current treatment algorithm of endoscopic surgical resection followed by radiation therapy.

Design Retrospective review of two recent cases from our institution over a 1-year period, with a relevant review of the literature.

Setting A large regional tertiary care facility.

Participants Consecutive cases of RCC with metastases to the sinonasal cavity presenting to our institution.

Main Outcome Measures Preoperative and postoperative sinonasal outcome test (SNOT)-22 scores, duration of hospital stay, complications, and local disease control

Results Patients in this series underwent preoperative embolization followed by endoscopic resection without complication. Postoperatively they were treated with radiation therapy. They experienced improvement in their SNOT-22 scores and are currently free of local disease.

Conclusion Metastatic RCC to the sinonasal cavity can be safely treated with preoperative embolization followed by endoscopic surgical resection and radiation therapy, which can result in improvement in sinonasal quality of life and is a potential adjunct for local control of disease.

Isolated multiple bilateral thyroid metastases from prostatic adenocarcinoma: case report and literature review

Solitary metastasis from prostate adenocarcinoma to thyroid gland is very rare and usually associated with other distal metastasis. This report describes for the first time isolated multiple bilateral thyroid metastasis from prostatic adenocarcinoma. A 67-year-old man who is known as a case of prostatic adenocarcinoma was admitted to a hospital as a case of a multinodular goiter on the basis of clinical and CT scan findings. Total thyroidectomy was performed and histopathology result showed adenomatous goiter containing bilateral metastatic prostatic adenocarcinoma. This is the first report of isolated multiple bilateral thyroid gland metastasis from prostatic adenocarcinoma without other distal metastasis. Such lesions are very rare and can be misdiagnosed, so high index of suspicion for thyroid metastasis should be always maintained in all oncology patients with isolated thyroid mass because early resection and thyroidectomy will change the prognosis for patient.

Thyroid gland metastasis arising from primary liver cholangiocarcinoma: The first case report involving surgical operation

INTRODUCTION

A primary cancer causing thyroid metastasis is extremely rare. In western countries, the most common primary tumors causing thyroid metastases include kidney, lung, breast, and gastrointestinal cancers. In contrast, breast is the most common primary site, followed by kidney, colon, and lung cancers in Korea. To the best of our knowledge, surgically confirmed thyroid metastasis from cholangiocarcinoma has not been reported. Herein, we report the first case of thyroid metastasis secondary to cholangiocarcinoma on which surgery was performed.

PRESENTATION OF CASE

A 55-year-old man was diagnosed with hepatic malignancy in December 2008. He subsequently received 2 cycles of transarterial chemoembolization and 4 cycles of radio-frequency ablation between 2008 and 2010. At follow-up in January 2011, brain metastasis was identified in the right parietal area secondary to cholangiocarcinoma. In April 2011, the patient was found to have palpable masses on the left thyroid and lateral neck. The patient subsequently underwent total thyroidectomy followed by left radical neck dissection. Intraoperatively, an ill-defined mass measuring 6.0 cm was found infiltrating the subcutaneous tissue into the prevertebral fascia. Microscopic and immunohistochemical findings confirmed that the thyroid masses and lymph nodes were metastatic cholangiocarcinoma.

DISCUSSION

Positive immunohistochemical staining for cytokeratin 7, cytokeratin 19, and AFP and negative results for TG, TTF-1, and cytokeratin 20 can be definitely helpful in arriving at a correct diagnosis.

CONCLUSION

To the best of our knowledge, this is the first case report on surgically resected thyroid and lateral neck metastases secondary to cholangiocarcinoma.

Atypical presentations and rare metastatic sites of renal cell carcinoma: a review of case reports

Renal cell carcinoma is a potentially lethal cancer with aggressive behavior and a propensity for metastatic spread. Due to the fact that the patterns of metastases from renal cell carcinomas are not clearly defined, there have been several reports of cases of renal cell carcinoma associated with rare metastatic sites and atypical presenting symptoms. The present review focuses on these atypical rare clinical presentations of renal cell carcinomas both at the time of diagnosis of the primary tumor but also in the years after radical nephrectomy.