Metastases to the Thyroid Gland: What Can We Do?

Case report: Thyroid metastasis from hepatocellular carcinoma: a rare case with diffuse solid occupancy and unusual imaging findings

Background

Thyroid metastasis represents a rare occurrence, with commonly observed primary tumors originating from renal cell carcinoma, malignant neoplasms of the gastrointestinal tract, lungs, and breast. However, the metastasis of hepatocellular carcinoma to the thyroid gland remains infrequent. Previous investigations have consistently demonstrated an unfavorable prognosis for patients with malignancies that have metastasized to the thyroid. In this context, we present a noteworthy case of thyroid metastasis from hepatocellular carcinoma (HCC), characterized by a distinct ultrasonographic manifestation of diffuse thyroid lesion, deviating from the previously documented imaging presentations of thyroid metastases in HCC.

Case presentation

A 62-year-old Chinese female patient was diagnosed with hepatocellular liver cancer in 2019, following which she underwent a radical hepatic resection. Pathological examination revealed HCC located in the right lobe (stage T3bN0M0 IIIB). No additional interventions were administered subsequent to the surgery. After a span of 15 months, the patient presented with dyspnea. Ultrasonographic findings showed diffuse solid infiltration within the thyroid gland, along with tumor thrombi in both internal jugular veins. Computed tomography (CT) scans demonstrated malignant thyroid lesions infiltrating the retropharyngeal space, prevertebral space, and esophageal wall. The subsequent pathology report from the puncture biopsy confirmed the malignant nature of the tumor, and immunohistochemical analysis definitively established its hepatic origin.

Conclusions

Patients with a history of HCC should be subjected to long-term monitoring and habitual thyroid ultrasonography. Newly detected thyroid nodules in such patients should be immediately regarded suspect for potential metastatic disease. Even when a nodule doesn't exhibit malignant characteristics on ultrasound, FNAB should be administered promptly to elucidate the pathological condition. Larger, swiftly multiplying thyroid masses should warrant an immediate CNB. The identification of thyroid metastases, particularly when coupled with peripheral tissue invasion, typically signifies a bleak prognosis.

Thyroid gland: a rare site of metastasis

PURPOSE

Despite its rich vascularity, metastasis (MTS) to the thyroid tissue is unusual, ranging from 1 to 3%. This entity is not usually considered as differential diagnosis and is not included in the upfront approach in patients with thyroid nodules. Once diagnosed, treatment is controversial. The aim of this study was to evaluate diagnosis, treatment, and outcome at the end of follow-up in patients with a diagnosis of MTS to the thyroid.

METHODS

A retrospective multicenter study was designed from 1985 to 2022; 29 patients with MTS to the thyroid gland were included in the analysis.

RESULTS

Clinical presentation included the presence of a nodular goiter (65.5%), compression symptoms (17.2%), diffuse goiter (10.3%), and suspicious lymph nodes in the neck (7%). Primary tumor sites were: kidney (44.8%), breast (24.1%), lung (13.8%), neuroendocrine system (6.9%), colon (3.4%), cervix (3.4%), and ovary (3.4%). In 18/23 patients, suspicious ultrasound criteria for malignancy were described. Preoperative diagnosis was made in 23/27 patients by FNA and confirmed in 18 cases by immunohistochemistry. Seventeen patients underwent surgery. At the end of the follow-up, 19 patients had died of oncological disease, and six were alive (2/6 disease-free with isolated intrathyroidal MTS).

CONCLUSION

Renal carcinoma was the tumor that most frequently metastasized to the thyroid gland. Immunodiagnosis was a very useful tool for etiological confirmation. Patients with MTS to the thyroid gland as a unique site had a more favorable course compared to patients with multiple metastatic sites. Finally, outcomes and prognosis essentially depended on the biology of the primary tumor.

Outcomes of thyroidectomy for secondary thyroid malignancies, a single center experience

BACKGROUND

Metastasis of primary malignancies of other organs to the thyroid gland is a rare condition that may pose a diagnostic challenge. In this study, we aimed to report the clinicopathologic features and outcomes of patients treated for secondary thyroid malignancies in our center.

MATERIALS AND METHODS

The results of patients who underwent thyroidectomy in our clinic between 2015 and 2023 were evaluated retrospectively. Four patients who met the inclusion criteria were evaluated.

RESULTS

The primary tumor was renal cell carcinoma in 2 patients and squamous cell carcinoma of the lung in 2 patients. Median age was 64 years (min:59-max:69). The median nodule diameter was 2.85 cm. Extrathyroidal spread was present in 1 patient with renal cell carcinoma metastasis. The other patient with renal cell carcinoma metastasis had lymphatic invasion. Vascular invasion was detected in 1 patient with renal cell carcinoma metastasis and 1 patient with squamous cell carcinoma of the lung metastasis. Surgical margin positivity was present in 1 patient in each group. The median overall survival time was 27 (min:10-max:44) months in the renal cell carcinoma group and 11 (min:6-max:16) months in the squamous cell carcinoma group. After the diagnosis of primary renal cell carcinoma, one patient metastasized to thyroid tissue 43.00 and one patient 94.00 months later. In the squamous cell carcinoma group, one patient showed metastasis to thyroid tissue 6.00 months after the primary diagnosis, while the other patient was first diagnosed with metastatic tissue.

CONCLUSIONS

Metastasis to the thyroid gland is a rare phenomenon with an incidence of 0.22% in all thyroid malignancies. It may occur before the detection of the primary tumor or during the follow-up of the primary malignancy. Although the overall prognosis is poor, it can be treated surgically.

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.

Tumor-to-tumor spread: a case report and literature review of renal cell carcinoma metastasis into thyroid cancer

Tumor-to-tumor metastasis is a rare, yet important entity. Patients with a history of renal cell carcinoma (RCC) may have tumor deposits to the thyroid gland preceding or following their initial cancer diagnosis for many years. The diagnosis can be challenging, and clinicians must remain suspicious of a newly found thyroid nodule in a patient with a history of RCC. In this review, we report a case of a patient with RCC who was incidentally found to have a thyroid nodule on surveillance imaging found to be consistent with tumor-to-tumor metastasis from RCC into papillary thyroid carcinoma. It is imperative to consider this diagnosis as the thyroid is the most common site of spread, and treatment with partial or total thyroidectomy has led to improved survival.

Issues with the targeted therapy of non‑small cell lung cancer with thyroid metastases: A case report

Lung cancer is a common malignancy that has usually already metastasized at the time of diagnosis; however, thyroid metastases are extremely rare. Echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (ALK) fusion has been observed in 3-7% of cases of lung adenocarcinoma. ALK inhibitor therapy has been shown to exert a positive effect on disease progression. The present study describes the case of a patient with ALK-positive non-small cell lung carcinoma and thyroid metastases who exhibited a minimal response to ALK inhibitor therapy in the primary lesion, but had a complete pathological response in the thyroid, as confirmed by a thyroid biopsy. The present case report undermines the need for further evidence from genomic testing following this different tumor course in thyroid tissue.

Ultrasonographic Findings and Prognosis of Metastases to the Thyroid Gland

Metastases to the thyroid gland (MTT) are uncommon in clinical practice. The ultrasound (US) features are easily confused with primary thyroid malignancy, Hashimoto's thyroiditis, and other thyroid diseases. Therefore, this study aimed to assess the role of US and analysis of prognosis of MTT. A total of 45 patients with MTT in the database between July 2009 and February 2022 at the Fujian Cancer Hospital were reviewed. US examinations were performed only on 20 patients, who were finally included in our study. Among the 20 patients, nine were male, and eleven were female. According to US characteristics, metastases to the thyroid gland were divided into nodular and diffuse types (17 and 3 cases, respectively). Three lesions (17.6%) had circumscribed margins, and 14 (82.4%) were uncircumscribed. Three lesions (17.6%) were regular in shape, and 14 (82.4%) were irregular. Nine metastases (52.9%) were a taller-than-wide shape, and eight (47.1%) were not a taller-than-wide shape. Ten lesions (58.8%) had rich vascularity, and seven (41.2%) had absence/not rich vascularity. The mean overall survival (OS) from the time of MTT diagnosis was 22 months (95% confidence interval: 5.95-38.05). The 1-, 3-, and 5-year OS after metastasis was 68.1%, 25.5%, and 17%, respectively. The prognosis of MTT was poor, which is closely related to the characteristics of the primary tumor and metastatic disease. The US findings and US-guided core needle biopsy may be useful in diagnosing MTT in patients with a history of the malignant tumors.

Fast Track Management of Primary Thyroid Lymphoma in the Very Elderly Patient

A rapid growing cervical mass mobile while swallowing is the most common clinical presentation of severe thyroid malignancy. A 91-year-old female patient with a history of Hashimoto thyroiditis presented with clinical compressive neck symptoms. The patient had gastric Maltoma diagnosed that was surgically resected thirty years ago. A straightforward process was needed to reach full histological diagnosis and initiate prompt therapy. Ultrasound (US) showed a 67 mm hypoechoic left thyroid mass with reticulated pattern without signs of locoregional invasion. Percutaneous trans isthmic US-guided 18G core needle biopsy (CNB) disclosed diffuse large B cell lymphoma of the thyroid gland. FDG PET revealed two distinct thyroid and gastric foci (both SUVmax 39.1). Therapy was initiated rapidly to decrease clinical symptoms in this aggressive stage III primitive malignant thyroid lymphoma. The prognostic nomogram was calculated by using a seven-item scale, which disclosed a one-year overall survival rate of 52%. The patient underwent three R-CVP chemotherapy courses, then refused further treatment and died within five months. Real-time US-guided CNB approach led to rapid patient's management that was tailored to patient's characteristics. Transformation of Maltoma into diffuse large B cell lymphoma (DLBCL) into two body areas is deemed to be extremely rare.

Thyroid Metastasis from Primary Breast Cancer

Breast cancer (BC), the most commonly diagnosed malignancy, frequently metastasizes to the bone, lungs, brain and liver at advanced stages, whereas the thyroid gland represents a rare target site for secondary disease. We examined the most recent literature about thyroid metastasis (TM) from BC after we encountered a peculiar case of a 71-year-old woman who developed sudden dysphagia, severe hypothyroidism and hypoparathyroidism due to TM 18 years after the diagnosis of her primary cancer. Based on published data, the prevalence of TM in BC ranges from 3% to 34%, with a median onset time of 48.2 months, although longer time intervals are not infrequent. TM negatively impacts the prognosis of these patients, however thyroid surgery can limit the local disease burden. Therefore, we suggest that clinicians involved in the follow-up care of BC patients should consider a differential diagnosis of secondary thyroid malignancy when incidental lesions are diagnosed during radiological evaluations or local symptoms affect the cervical region, even many years after the diagnosis of the primary cancer.

Neuroendocrine neoplasm with metastasis to the thyroid: a case report and literature review

Thyroid cancer can be divided into two types according to its cellular origin, i.e., malignant tumors originating from thyroid cells and cancers that metastasize to the thyroid from other sites, the latter of which are, clinically rare. This article reports the diagnosis and treatment of a rectal neuroendocrine neoplasm metastasis to the thyroid. No similar cases have been reported before. This case suggests that when evaluating thyroid tumors, clinicians should not only carefully identify the clinical features of the tumor but also pay special attention to the patient's history of tumors, especially neuroendocrine neoplasms. For definite secondary thyroid malignancies, neck surgery is feasible if the thyroid is the only site of metastasis; otherwise, the subsequent diagnosis and treatment plan should be determined after a comprehensive evaluation of the primary tumor and patient's general condition.