Metastasis of Renal Clear Cell Carcinoma to Thyroid Gland Mimicking Adenomatous Goiter

Characterization of thyroid metastasis from clear cell renal cell carcinoma on ultrasonography: a report of three cases and literature review

Introduction

Thyroid metastasis from clear cell renal cell carcinoma (ccRCC) is relatively rare, so ultrasound doctors lack experience with the disease, which can easily lead to misdiagnosis. We describe three cases of thyroid metastasis from ccRCC detected 12, 8, and 7 years after nephrectomy.

Case presentation

The first patient, a 78-year-old woman, was admitted to our institution for hoarseness and progressive dyspnea. Ultrasonography revealed bilateral thyroid nodules and abnormal cervical lymph nodes. Fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) of the thyroid was nondiagnostic. The other two patients, a 54-year-old man and a 65-year-old man, were admitted to our institution for a goiter pressing on the trachea. In each case, ultrasonography revealed a partially cystic nodule of the left lobe of the thyroid gland. Histological examination of three patients after thyroidectomy showed thyroid metastasis from ccRCC.

Discussion/Conclusion

For patients with a history of ccRCC, long-term follow-up and routine thyroid ultrasonography should be performed. If a new thyroid nodule is found during the examination, metastases should be highly suspected. FNAB should be performed, even if benign ultrasound features seem to be in evidence. If the diagnosis of FNAB is incorrect and inconclusive, CNB should be performed.

Clear-cell renal cell carcinoma single thyroid metastasis: A single-center retrospective analysis and review of the literature

Renal cell carcinoma (RCC) is known to cause metastasis to unusual sites, which can be both synchronous or metachronous. Thyroid gland is a rare site for metastasis. However, RCC is the most common primary neoplasm to metastasize to the Thyroid gland. Report of three cases and review of the literature.

Ultrasonographic characteristics of thyroid metastasis from clear cell renal cell carcinoma: A case report

INTRODUCTION

Thyroid metastasis from clear cell renal cell carcinoma (ccRCC) is a very rare condition, and its ultrasonographic characteristics have not been summarized in the literature. We herein report a case of thyroid metastasis from ccRCC that occurred 11 years after the surgery and the ultrasonographic characteristics of it are described.

PATIENT CONCERNS

A 57-year-old male patient was admitted to our hospital in September 2018 due to discomfort in the neck. No other abnormalities were found during laboratory examination of thyroid function. The previous medical history of the patient included a right nephrectomy for the treatment of ccRCC in June 2007.

DIAGNOSIS

Ultrasound examinations revealed multiple thyroid nodules. After nephrectomy, there was no obvious abnormality in the right renal area. Computed tomography (CT) showed an oval lesion with slightly lower density in the right lobe of the thyroid, and the patient was initially diagnosed with nodular goiter.

INTERVENTIONS

Bilateral partial thyroidectomy under general anesthesia was conducted. Intraoperative frozen pathological examination showed clear cell carcinoma in the right lobe of the thyroid gland. Therefore, total thyroidectomy and lymph node dissection in the central neck area were performed.

OUTCOMES

The patient underwent surgical treatment and recovered successfully. The patient was followed up for 2 years with no further metastasis.

CONCLUSION

Ultrasound examination is a safe and convenient screening method. For patients with a renal malignant tumor, if the ultrasound image of thyroid nodule is found to have the characteristics of malignant tumors, the occurrence of metastasis of renal cancer to the thyroid should be highly suspected. Core needle biopsy (CNB) and histopathological diagnosis should be conducted subsequently for early diagnosis.

A Rare Case of Metastasis of Renal Clear Cell Carcinoma to the Thyroid Gland, Presenting as a Goiter Nodule, Three Years After Nephrectomy

Thyroid gland metastatic tumors are rare in clinical practice. Clear cell RCC is one of common metastatic tumors to thyroid. We here reported a case of incidentally found clear cell renal carcinoma metastasis to the thyroid gland 3 years after nephrectomy, in the thyroidectomy procedure performed for the patient due to the thyroid enlargement caused by multinodular goiter. A 65-year-old Iranian man with a history of multinodular goiter referred to our surgery clinic for thyroidectomy because of compressive effects on the trachea. Patient had a history of nephrectomy due to clear cell RCC 3 years ago. After thyroidectomy, gross and histological examination of thyroid revealed clear cell renal carcinoma metastasis to the thyroid gland in the setting of a multinodular goiter. The diagnosis was confirmed by immunohistochemistry staining. Patients with multinodular goiter are more prone to present with metastasis to thyroid gland if they have a history of malignancy, especially renal cell carcinoma.

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.

Colon Cancer Metastasis Within a NIFTP: A Case Report and Review of the Literature

The thyroid is an unusual site for metastasis, and metastases in a preexisting primary thyroid tumor are exceedingly rare. We report the first case of a patient with colon cancer who was diagnosed with a thyroid metastasis in a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). A 55-year-old male patient presented with a 19 mm thyroid nodule in the inferior left lobe. It was EU-TIRADS 5 on echography and suspicious of papillary thyroid carcinoma (Bethesda V) on cytology. Macroscopically, the nodule was fleshy and completely encapsulated. At frozen section examination, it demonstrated follicular architecture with mild atypia. Inside the nodule was a focus of tumor with glandular architecture, marked cellular atypia, and necrosis. These findings suggested a secondary malignancy. The patient's medical history was significant for metastatic colon cancer. The definitive histology showed features of metastatic colorectal adenocarcinoma within a NIFTP. Immunohistochemical studies were confirmatory with expression of CDX2 and CK20 localized to the metastatic focus. PAX8, TG, and TTF were negative in the metastasis but expressed in the surrounding NIFTP lesion. The possibility of a metastasis to the thyroid may be considered in patients presenting with a solitary thyroid nodule with a previous history of cancer. Metastatic colorectal adenocarcinoma occurring in a NIFTP has never been reported before now, although metastases to the thyroid are documented in the literature. In cases of a secondary malignancy to the thyroid, treatment is controversial.

A Multimodal and Pathological Analysis of a Renal Cell Carcinoma Metastasis to the Thyroid Gland 11 Years Post Nephrectomy

Thyroid lesions have a comprehensive differential diagnosis which include benign and malignant entities, such as metastases. However, metastases only account for a small percentage of thyroid lesions with renal cell carcinoma as the most common. Metastases to the thyroid pose a diagnostic dilemma as symptoms may not manifest for up to decades after removal of the renal cell carcinoma. Due to the nonspecific appearance on computed tomography and ultrasound, distinguishing metastases from primary thyroid malignancies is of the utmost importance for timely patient management. Our case demonstrates the importance of considering RCC metastases to the thyroid even years after nephrectomy to mitigate potential delays in diagnosis. We present the case of a 66-year-old male with a past medical history of renal cell carcinoma status post nephrectomy 11 years prior who demonstrated incidental thyroid abnormalities on positron emission tomography/computed tomography and ultrasound later confirmed as a metastasis of renal cell carcinoma.

Renal Cell Carcinoma Metastases to the Pancreas and the Thyroid Gland: A Case Report and Review of the Literature

Renal cell carcinoma (RCC) is known for having unpredictable clinical behavior. Metastases can occur in unusual locations with a long-time lag after the treatment of the primary cancer. Despite being a sign of poor prognosis, aggressive metastasectomy may prolong survival. Presented is a case of delayed sequential metastases of RCC to the pancreas and the thyroid gland that occurred eight years after the radical nephrectomy. Both were resected. A history of remote nephrectomy for RCC is important and may be suggestive of metastatic disease. Ultrasound-guided fine needle aspiration can be diagnostic and helps in decision-making. Aggressive surgical intervention when possible is recommended.

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.

Thyroid Gland Hemorrhage in a Patient with Past Medical History of Renal Clear Cell Carcinoma: Report of a Very Rare Case

BACKGROUND The incidence of metastasis to the thyroid gland is extremely rare, with hemorrhage being a particularly uncommon manifestation of metastatic thyroid disease. CASE REPORT A 68-year-old man who underwent a right nephrectomy for RCC 8 years ago was referred to the Emergency Department (ED) complaining of upper-chest pain radiating to the left shoulder, tachycardia, and increased dysphonia. An enhanced computed tomography (CT) scan suggested a thyroid mass originating from both thyroid lobes, with right deviation of the trachea due to active bleeding. The patient underwent an emergency total thyroidectomy. The postoperative course was uneventful. The histopathological analysis of the surgical specimen revealed metastasis of an RCC. CONCLUSIONS Active bleeding of the thyroid gland is a formal indication for emergency surgical management. In patients with a history of cancer, especially in cases of RCC, metastatic disease should be suspected, although in most cases the final diagnosis can only be made after surgery.