Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report

Subcutaneous implantation of nodular goiter after transoral endoscopic thyroidectomy vestibular approach: A case study and review of literature

BACKGROUND

Extrathyroid implantation or dissemination of thyroid tissue secondary to a thyroid procedure is rare. Most of these belonged to thyroid carcinoma with metastatic potential and uncommon for benign pathologies.

METHODS

We report the case of a 31-year-old female who was identified to have multiple subcutaneous implantation of thyroid tissue 5 years after transoral endoscopic thyroidectomy vestibular approach. A comprehensive literature search on implantation of thyroid tissue secondary to thyroid procedures was performed.

RESULTS

Accidental tearing of the capsule during previous surgery may lead to the subcutaneous implantation. Through literature review, a total 29 articles with 47 patients were identified. 33.3% were benign lesions, and implantation was mostly secondary to fine needle aspiration biopsy (46.5%).

CONCLUSIONS

Subcutaneous or port site implantation after endoscopic thyroid surgery may occur in benign thyroid pathologies and therefore, oncologic principles must be strictly followed during surgery regardless of its histopathological nature.

Subcutaneous implantation of thyroid carcinoma and benign tissue after thyroidectomy: report on two cases and review of the current literature

Background

Subcutaneous implantation of thyroid tissue after thyroidectomy is a rare occurrence involving both benign and malignant thyroid tissue. Clinically, subcutaneous implantation of thyroid tissue can be challenging to diagnose. We present two cases of subcutaneous implantation of thyroid tissue following thyroidectomy and discuss the differential diagnosis, clinicopathological characteristics, and the possible mechanism of implantation.

Case Description

A 35-year-old woman (age in 2009) who underwent total thyroidectomy in 2009 whose histopathological examination revealed a nodular hyperplasia and lymphocytic thyroiditis complained of palpable mass in her neck 10 years after operation and underwent excision. Follicular adenoma was confirmed in histopathological results. A 58-year-old woman (age in 2010) who underwent lobectomy in 2010 for nodular hyperplasia had a 6 cm sized huge mass in her anterior neck 9 years after operation. Anterior neck mass excision was done and poorly differentiated carcinoma was confirmed in histopathological results. The patient showed no sign of recurrence after 3 years follow-up.

Conclusions

Subcutaneous implantation of benign thyroid tissue or thyroid cancer can occur after thyroidectomy. Minimizing the likelihood of subcutaneous implantation requires careful consideration of various factors at every stage of the surgical procedure. Surgeons should be aware of this potential long-term complication that can occur in both conventional thyroidectomy and remote access surgery, effectively communicate and provide appropriate guidance to their patients, and try to avoid seeding of both malignant and benign thyroid tissue.

Needle tract seeding of a sclerosing epithelioid fibrosarcoma in a biopsy tract: a case report

BACKGROUND

A sclerosing epithelioid fibrosarcoma (SEF) is an uncommon tumor of the deep soft tissue. An SEF has been described as a low-grade tumor with high local recurrence and metastatic rates. Generally, in bone and soft tissue tumors, a resection of the biopsy route is recommended; however, there is limited evidence with respect to the dissemination of the tumor tissue during a needle biopsy.

CASE PRESENTATION

A mass in the right pelvic cavity, with no symptoms, was observed in a 45-year-old woman during a gynecological examination. Computed tomography (CT) revealed a multilocular mass with calcification in the pelvic cavity. The magnetic resonance imaging (MRI) showed an iso-signal intensity on T1 weighted images and hypo- and iso-signal intensity on T2 weighted images. The CT-guided core needle biopsy was performed using a dorsal approach, and the biopsy diagnosis was a low-grade spindle cell tumor. The tumor was excised using an anterior approach. The tumor tissue comprised spindle cells and epithelioid cells with irregular nuclei, and the immunohistological analysis was positive for vimentin and epithelial membrane antigen, which was consistent with a diagnosis of sclerosing epithelioid fibrosarcoma. Five years after the surgery, the MRI showed a tumor recurrence in the subcutaneous tissue of the right buttock, which was consistent with the needle biopsy tract. The patient underwent a tumor excision, and the resected tumor was similar to the primary tumor.

CONCLUSIONS

The recurrent tumor was excised with a surgical margin, and the tumor specimen had the histological features of a sclerosing epithelioid fibrosarcoma. It was difficult to investigate the association of the core needle biopsy with the tumor recurrence because the approach of the biopsy tract is usually same as that used in a tumor excision. However, the present case indicated the tumor may recur in the biopsy tract of a soft tissue sarcoma. Surgeons should be aware of the possibility of disseminating tumor tissues in a needle biopsy.

BRAFV600E and TERT promoter C228T mutations on ThyroSeq v3 analysis of delayed skin metastasis from papillary thyroid cancer: a case report and literature review

BACKGROUND

Skin metastasis from papillary thyroid cancer (PTC) is a rare entity that can occur up to decades after treatment of the primary tumor. Here, we present a patient who developed skin metastasis 10 years after treatment of her primary tumor and describe the molecular findings of the metastatic lesion.

CASE PRESENTATION

A 44-year-old female with a history of PTC who underwent a total thyroidectomy and radioactive iodine (RAI) treatment 10 years ago presented with a 1.3-cm skin lesion along the prior thyroidectomy scar. A biopsy revealed metastatic PTC, and the patient underwent surgical excision of the lesion. ThyroSeq molecular testing showed the copresence of BRAF^V600E mutation and TERT promoter C228T mutation. The patient subsequently received one round of adjuvant RAI therapy.

CONCLUSIONS

A high index of suspicion is warranted in patients with a history of PTC who develop a skin lesion, even several years after remission of the primary disease. In patients with high-risk mutations, such as BRAF^V600E and TERT promoter C228T mutations, long-term surveillance of disease recurrence is particularly important.