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Orlandi AM, Alcaraz G, Bielski L, Brenta G, Jozami LC, Cavallo A, Guerra J, Zund S. Thyroid gland: a rare site of metastasis. Endocrine 2024; 84:607-614. [PMID: 38224445 DOI: 10.1007/s12020-023-03626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024]
Abstract
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.
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Affiliation(s)
- Ana María Orlandi
- Endocrinology Department, Hospital Dr. T. Álvarez, Buenos Aires, Argentina.
| | - Graciela Alcaraz
- Endocrinology Department, Hospital Dr. C. Durand, Buenos Aires, Argentina
| | - Laila Bielski
- Endocrinology Department, Sanatorio Güemes, Buenos Aires, Argentina
| | - Gabriela Brenta
- Endocrinology Department, Unidad Asistencial Dr. C. Milstein, Buenos Aires, Argentina
| | | | - Andrea Cavallo
- Endocrinology Department Hospital Alta Complejidad, Formosa, Argentina
- Endocrinology Department Hospital Universitario Austral, Buenos Aires, Argentina
| | - Jorgelina Guerra
- Endocrinology Department Hospital Universitario Austral, Buenos Aires, Argentina
| | - Santiago Zund
- Head and Neck Surgery Department, Instituto de Oncología A. Roffo, Buenos Aires, Argentina
- Head and Neck Surgery Department Hospital Español de La Plata, Buenos Aires, Argentina
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Deniz MS, Özdemir D, İmga NN, Başer H, Çuhacı Seyrek FN, Altınboğa AA, Topaloğlu O, Ersoy R, Çakır B. Investigation of pre-operative demographic, biochemical, sonographic and cytopathological findings in low-risk thyroid neoplasms. Clin Endocrinol (Oxf) 2023; 99:502-510. [PMID: 37708141 DOI: 10.1111/cen.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The present article analyses pre-operative demographic, biochemical, sonographic and histopathological characteristics of low-risk thyroid neoplasms (LRTNs), with a focus on four subgroups, "well-differentiated carcinoma-not otherwise specified" (WDC-NOS), "non-invasive follicular thyroid neoplasm with papillary like nuclear features" (NIFTP), "well-differentiated tumours of uncertain malignant potential" (WDT-UMP) and "follicular tumour of uncertain malignant potential" (FT-UMP). METHODS The study retrospectively analyzed the histopathology of 2453 malignant thyroids and the final analyses included 99 cases diagnosed with LRTNs. The demographic and clinical features, pre-operative thyroid function, ultrasonography results, cytopathology results, histopathology results and prognostic classifications were assessed. RESULTS The groups were similar demographic characteristics and the majority of clinical data, including comorbidities, thyroid function tests, thyroid cancer/neck radiotherapy history. NIFTPs represented 69.7% of all LRTNs. All (100%) WDT-UMPs had solitary nodules. Index nodule volume differed among the groups (p = .036), it was the lowest in WDC-NOS [0.68 (0.63-0.72 cc)] and highest in FT-UMP [12.6 (0.5-64 cc)]. Echogenicity findings were similar. Index nodule TIRADS demonstrated a significant difference (p = .021) but index nodule halo sign and BETHESDA scores were similar in all groups. The diameter, localisation and multicentric structure of LRTNs were again similar for all groups. Finally, prognostic scores suggested similar outcomes in all groups. CONCLUSION The majority of LRTNs were NIFTPs in our population and all WDT-UMPs were solitary lesions. Index nodule volume was the most essential discriminating sonographic finding but further research must be performed before discriminatory potential can be described.
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Affiliation(s)
- Muzaffer Serdar Deniz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Education and Research Hospital, Karabük University, Karabük, Turkey
| | - Didem Özdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Narin Nasıroğlu İmga
- Department of Endocrinology and Metabolism, Health Sciences University, Ankara City Hospital Endocrinology and Metabolic Diseases Clinic, Ankara, Turkey
| | - Hüsniye Başer
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Fatma Neslihan Çuhacı Seyrek
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ayşegül Aksoy Altınboğa
- Department of Pathology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Oya Topaloğlu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Çakır
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Garneau M, Alyzadneh E, Lal G, Rajan Kd A. Metastatic Disease to a Concurrent Thyroid Neoplasm: A Case Series and Review of the Literature. Head Neck Pathol 2023; 17:447-459. [PMID: 36719557 PMCID: PMC10293528 DOI: 10.1007/s12105-022-01509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metastatic disease to the thyroid gland is uncommon but well-described. Metastatic disease to a concurrent primary thyroid neoplasm is a rare phenomenon. We sought to study patients with metastasis to the thyroid with a focus on the histopathologic and clinical features in tumor-to-tumor metastasis. METHODS We identified a series of patients with metastatic disease to the thyroid, with or without a concurrent primary neoplasm, through a search of the files of the Department of Pathology. All relevant slides were retrieved and reviewed, including routine HE and immunohistochemical stains. We performed a detailed English language literature search (1962-2022) and review to identify tumor-to-tumor metastasis involving the thyroid. RESULTS We identified 14 patients with metastasis to the thyroid over a 22-year period. Four patients exhibited papillary thyroid carcinoma, with metastatic spread of a different malignancy seeding into the thyroid cancer. We describe the histopathologic diagnostic process and findings, clinical management, and the clinical course of tumor-to-tumor metastasis in greater detail for these 4 patients. CONCLUSION Tumor-to-tumor metastasis to the thyroid is a rare event with unique histopathologic features. Our findings suggest that the phenomenon of tumor-to-tumor metastasis serves to highlight broader mechanisms of metastatic disease in general. We provide the largest-to-date and comprehensive review of the literature to identify all previous reported instances of tumor-to-tumor metastasis involving the thyroid.
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Affiliation(s)
- Michael Garneau
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 52242, Iowa City, IA, USA
| | - Eyas Alyzadneh
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Geeta Lal
- Department of Surgery, University of Iowa Hospitals and Clinics, 52242, IA, Iowa City, USA
| | - Anand Rajan Kd
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
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Hellums RN, Kovatch KJ, Friscia ME, Schwartz TR, Pellitteri PK. Metastatic renal cell carcinoma to the thyroid with cervicothoracic venous tumor thrombosis. Head Neck 2023. [PMID: 37141398 DOI: 10.1002/hed.27391] [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: 01/29/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Metastatic renal cell carcinoma (RCC) represents 25%-42% of metastatic thyroid malignancies. Propensity for RCC to demonstrate intravascular extension to the inferior vena cava is well documented. We present an analogous phenomenon of intravascular extension to the internal jugular vein (IJV) from thyroid gland metastasis. METHODS A 69-year-old male presented with metastatic RCC of the right thyroid lobe. Imaging demonstrated tumor thrombosis of the ipsilateral IJV, extending inferiorly to the junction of the brachiocephalic, subclavian, and internal jugular veins within the mediastinum. RESULTS Surgical excision required control of both the IJV in the neck and mediastinal venous great vessels via sternotomy, prior to subtotal thyroidectomy and venotomy for en bloc resection. CONCLUSION This case report describes metastatic RCC to the thyroid gland with cervicothoracic venous tumor thrombosis successfully treated with subtotal thyroidectomy, sternotomy for venotomy and tumor thrombectomy, and preservation of IJV conduit.
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Affiliation(s)
- Ryan N Hellums
- Department of Otolaryngology - Head & Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Kevin J Kovatch
- Department of Otolaryngology - Head & Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Michael E Friscia
- Department of Thoracic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Tyler R Schwartz
- Department of Otolaryngology - Head & Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Phillip K Pellitteri
- Department of Otolaryngology - Head & Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
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Zhang Y, Lin B, Lu KN, Teng YP, Zhou TH, Da JY, Wu F, Pan G, Luo DC. Neuroendocrine neoplasm with metastasis to the thyroid: a case report and literature review. Front Oncol 2023; 13:1024908. [PMID: 37188185 PMCID: PMC10179498 DOI: 10.3389/fonc.2023.1024908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
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.
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Affiliation(s)
- Yu Zhang
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bei Lin
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kai-ning Lu
- Department of Breast Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yue-ping Teng
- Department of Operating Room, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tian-han Zhou
- Department of General Surgery, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Jia-yang Da
- Department of Dermatology, Third People's Hospital of Hangzhou, Hangzhou, China
| | - Fan Wu
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gang Pan
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ding-cun Luo
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- *Correspondence: Ding-cun Luo,
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Nguyen M, He G, Lam AKY. An update on the current epidemiological status of metastatic neoplasms to the thyroid. Cancer Epidemiol 2022; 79:102192. [PMID: 35653937 DOI: 10.1016/j.canep.2022.102192] [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: 01/29/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
Secondary tumours to the thyroid gland are uncommon with an overall prevalence of 5.9% in autopsy studies. In recent clinical series, secondary thyroid cancer is seen in only 1.9% of malignant thyroids. There is no gender predominance both overall (female to male 1.07:1) and when stratified by common histological subtypes (renal cell carcinoma, lung adenocarcinoma and colorectal adenocarcinoma). The median age of patients diagnosed with metastatic thyroid tumours in major studies ranges from 54 to 68 years. Metastases are more frequent in patients with pre-existing or concurrent thyroid pathology. In autopsy studies, the most common primary sites are breast carcinoma and lung carcinoma. Renal cell carcinoma, lung carcinoma and breast carcinoma predominate in clinical series. Upper aerodigestive tract primaries often directly infiltrate the thyroid gland. The underlying frequency of a histological subtype, geographic prevalence and aggressiveness of primary cancer likely contributes to the incidence of metastasis in the thyroid gland. This is seen in case series from Asia where gastric and oesophageal primary cancers predominate. Secondary thyroid cancer can present metachronously (60%), synchronously (34%), or as the first presentation of the underlying cancer (6%). Late metastases and first clinical presentations of disease often originate from renal cell carcinomas while synchronous cases tend to originate from the lungs. Other common primary sites for first presentation of secondary thyroid cancer include the lung and oesophagus. Although rare, secondary thyroid cancer should be considered as a differential particularly in patients with previous malignancy, such as from the kidney, lung, or breast.
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Affiliation(s)
- Marie Nguyen
- Cancer Molecular Pathology, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast Q4222, Australia.
| | - George He
- Cancer Molecular Pathology, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast Q4222, Australia.
| | - Alfred King-Yin Lam
- Cancer Molecular Pathology, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast Q4222, Australia; Pathology Queensland, Gold Coast University Hospital, Southport Q4215, Australia.
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Grimm D. Recent Advances in Thyroid Cancer Research. Int J Mol Sci 2022; 23:ijms23094631. [PMID: 35563021 PMCID: PMC9104463 DOI: 10.3390/ijms23094631] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Daniela Grimm
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark; ; Tel.: +45-21379702; Fax: +45-8612-8804
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Pfälzer Str. 2, 39106 Magdeburg, Germany
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt-und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany
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