Solitary Thyroid Metastasis of Renal Clear Cell Carcinoma: Report of a Case

A case of solitary thyroid metastasis of renal clear cell carcinoma is described. The patient was a 77-year-old Japanese woman, who was referred to our department after a thyroid tumor was identified in May 1999. She had a history of renal clear cell carcinoma of the left kidney, which had been partially resected 3 years previously. Ultrasound sonography demonstrated that a well-demarcated hypoechoic mass containing high-echo spots representing small calcifications, which measured 45 × 34 × 31 mm in size, occupied the left lobe. Computed tomography revealed a low-density mass containing small calcifications. The results of preoperative fine-needle aspiration cytology strongly suggested a clear cell carcinoma metastasizing to the thyroid. A left hemithyroidectomy was performed on July 27, 1999. A histological examination revealed that the neoplasm was composed of tumor cells with abundant clear cytoplasm and round nuclei. The histological characteristics of this thyroid tumor were virtually identical to the renal cell carcinoma resected3 years previously. Thyroglobulin stained negatively in the clear cells of the resected thyroid tumor in an immunohistochemical analysis. Clinically, the thyroid gland is a rare site of tumor metastasis; however, we should also consider the possibility of metastasis in the case of thyroid tumor patients with a history of renal cell carcinoma. Received: March 3, 2000 / Accepted: September 26, 2000     

Solitary metastasis from occult follicular carcinoma of the thyroid mimicking trigeminal neurinoma--case report

A 50-year-old woman presented with an extremely uncommon case of solitary metastasis from follicular carcinoma of the thyroid, which presented clinically as trigeminal neurinoma. Neuroimaging detected a tumor in the right petrous apex, which was removed surgically. Histological examination showed metastatic follicular carcinoma of the thyroid. However, no primary tumor was detected by various investigations. The tumor recurred twice, and was treated surgically both times. The patient finally agreed to adjuvant therapy for the suspected primary. Radiotherapy was performed followed by complete thyroidectomy. Examination of the gross specimen found the tumor nodule. Clinically significant metastasis can arise from histologically benign and silent follicular thyroid neoplasms.     

Insular carcinoma of the thyroid. An uncommon but aggressive neoplasm

Insular carcinoma of the thyroid is an infrequent entity, named in 1984 by Carcangiu when he described its characteristic histology. Clinically and morphologically it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic carcinoma of the thyroid, and most authors advise aggressive therapy, which in some cases can achieved prolonged survival. We describe 2 patients who experienced recurrence after treatment for the primary tumor. The recurrences were treated but the clinical courses differed.     

A case with poorly differentiated follicular carcinoma of the thyroid produced and secreted CEA

Detection of thyroglobulin, CEA, and calcitonin in serum and tissue is very useful to make differential diagnosis among papillary, follicular, and medullary carcinoma of the thyroid. The case was a 70-year-old woman with a nodule of the thyroid, presenting elevated serum level of thyroglobulin and CEA (22.0 ng/ml). Both serum level of thyroglobulin and CEA decreased after surgery. One year and nine months after surgery, she died from systemic metastases of thyroid carcinoma. Histological examination of the tumor presented to be poorly differentiated type of follicular carcinoma, presenting positive of both thyroglobulin and CEA, and negative of calcitonin in the cytoimmunochemistry. This case was identified to be a rare case that tumor cells of poorly differentiated follicular carcinoma produced and secreted both thyroglobulin and CEA.     

Diarrhea and medullary carcinoma of the thyroid.

The authors present the case of a 34-year-old woman with disseminated medullary carcinoma of the thyroid to emphasize the value of calcitonin assay in the diagnosis of this condition despite the absence of a thyroid mass and negative scans. An increased concentration of serum carcino-embryonic antigen was confirmed. The diarrhea associated with the disease did not respond to indomethacin in this patient suggesting that in some cases of medullary carcinoma diarrhea is not due to excessive production of prostaglandins.     

桥本病合并甲状腺癌的诊治

目的探讨桥本病合并甲状腺癌的诊断和治疗方法。方法回顾分析我院1993～2004年收治的15例桥本病合并甲状腺癌的临床资料。结果桥本病合并甲状腺癌的发病率占桥本病的13.4%(15/112),所有15例病人均主诉有颈部结节,13例TGA及TMA升高。手术方式主要为一侧或双侧甲状腺全切或次全切除。术后随访复发1例,转移2例。结论桥本病合并甲状腺癌术前诊断困难,术前常规检查TGA及TMA、术中常规作冰冻切片有助于提高桥本病的诊断。手术是最有效的治疗方法,应采取甲状腺癌根治性手术原则进行。     

Papillary Carcinoma in a Thyroglossal Duct Cyst

Papillary carcinoma arising in a thyroglossal duct cyst is a rare tumor. We report the case of 64-year-old man treated for thyroglossal duct cyst. Preoperatively, the thyroid gland was normal on physical examination and imaging studies. The Sistrunk procedure was done. The histopathological examination revealed thyroid papillary carcinoma. Postoperatively thyroid hormon was given to suppress serum TSH levels and the patient was followed at regular intervals. During a 5-year follow-up period, no recurrence of the disease occured.     

Papillary carcinoma in a thyroglossal duct cyst

Papillary carcinoma arising in a thyroglossal duct cyst is a rare tumor. We report the case of 64-year-old man treated for thyroglossal duct cyst. Preoperatively, the thyroid gland was normal on physical examination and imaging studies. The Sistrunk procedure was done. The histopathological examination revealed thyroid papillary carcinoma. Postoperatively thyroid hormon was given to suppress serum TSH levels and the patient was followed at regular intervals. During a 5-year follow-up period, no recurrence of the disease occured.     

Clinicopathologic significance of histologic vascular invasion in papillary and follicular thyroid carcinomas

BACKGROUND: The association of angioinvasion with tumor aggressiveness in follicular and papillary thyroid carcinoma remains unclear. This study addresses this problem focusing on clinicopathologic relevance of angioinvasion in the treatment of papillary thyroid carcinoma and follicular thyroid carcinoma. METHODS: From a university hospital database, 358 patients with papillary thyroid carcinoma or follicular thyroid carcinoma were randomly selected. Their charts were retrospectively analyzed and divided into papillary thyroid carcinoma and follicular thyroid carcinoma groups. Each group was subdivided into angioinvasive and nonangioinvasive tumor subgroups. All data were analyzed using Student's t-test, Mann-Whitney rank sum test, chi-square test, and Fisher's exact test. RESULTS: There were 289 women and 69 men, ages 18 to 89 years. Papillary thyroid carcinoma (86%) was more frequent than follicular thyroid carcinoma. Most patients had nonangioinvasive tumor (90.2%). After a mean followup of 43.6 months, there were no significant differences between papillary thyroid carcinoma subgroups for local recurrence (p = 0.69), persistent elevated serum thyroglobulin (p = 0.568), and distant metastasis rates (p = 0.422). No death related to the cancer was observed in both papillary thyroid carcinoma subgroups (p = 1), except for one death resulting from a concomitant nasopharyngeal cancer. The longterm prognosis was less favorable for angioinvasive papillary thyroid carcinoma based on AJCC (American Joint Committee on Cancer staging), AMES (age, distant metastasis, tumor extent, and size), and MACIS (distant metastasis, age, completeness of primary tumor resection, local invasion, and tumor size), but the angioinvasive papillary thyroid carcinoma were larger than nonangioinvasive papillary thyroid carcinomas. The short-term clinical outcomes in both follicular thyroid carcinoma, after a mean followup of 72.3 months, were comparable in terms of local recurrence (p = 0.34), persistent elevated serum thyroglobulin (p = 1), and distant metastasis (p = 0.597). There was no death related to cancer in both follicular thyroid carcinoma subgroups (p = 1). There were no significant differences between both follicular thyroid carcinoma subgroups for longterm prognosis. CONCLUSIONS: Our results indicate that angioinvasion does not adversely influence short-term outcomes or longterm prognosis in follicular thyroid carcinoma and short-term outcomes in papillary thyroid carcinoma. Angioinvasion is a postoperative pathologic finding that does not justify an ominous prognosis or drastic therapeutic measures.     

A case of renal cell carcinoma with metastasis to the thyroid gland and concomitant early gastric cancer

Metastatic lesions from renal cell carcinoma are commonly recognized in the lung and bone, however, thyroid metastasis has rarely been reported in the literature. We present herein a case of a man with lung and thyroid metastatic tumors from renal cell carcinoma. Although making a preoperative diagnosis of thyroid metastasis is difficult because there is no established diagnostic criteria, we were able to identify this thyroid lesion as a metastatic tumor from renal cell carcinoma by the pathological findings. Interestingly, hypercalcemia was recognized in this patient whose serum parathyroid hormone (PTH) level was not increased. Moreover, this patient also had early gastric cancer simultaneously, being a so-called double cancer. After surgical resection of the right kidney and stomach, interferon was administered without any efficacy against the metastatic lesions of the lung and thyroid gland.     

Mixed Medullary-Papillary Carcinoma of the Thyroid with Lymph Node Metastases: Report of a Case

We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.     

Insular carcinoma of the thyroid in a 10-year-old child

Thyroid carcinomas are relatively infrequent in the pediatric age group, the majority of which are papillary carcinomas. Poorly differentiated carcinomas are very rare in this age group. Insular carcinoma is a unique subset of poorly differentiated carcinoma of thyroid, which occurs predominantly in adults older than 50 years. In terms of prognosis, insular carcinoma of thyroid occupies a place in between that of well-differentiated papillary/follicular carcinoma and anaplastic carcinoma. The authors describe a case of insular carcinoma of thyroid in a 10-year-old girl who underwent hemithyroidectomy based on a preoperative diagnosis (by fine-needle aspiration cytology) of colloid goiter, and after histopathologic diagnosis of the specimen, a completion thyroidectomy was performed with block dissection of the neck. The authors believe this to be the youngest case of insular carcinoma of thyroid to be reported.     

Hashimoto's thyroiditis and medullary carcinoma in the same gland: a purely random occurrence?

In this paper the authors describe the case of 64-year-old woman who had been suffering from poorly defined thyroid disease for 30 years and Hashimoto's thyroiditis for 3 years, with recent detection of high serum calcitonin and CEA. Her family history was negative for endocrinological diseases and her general medical history was not significant for any diseases, except for mild hypertension. There were no pathological findings at physical examination. Cervical ultrasound showed 2 nodular lesions of the right lobe of the thyroid and the isthmus. FNABs of these nodules were performed under ultrasound control and proved non-diagnostic. The patient underwent total thyroidectomy. Intra-operative frozen sections were negative for cancer. Definitive histological examination was positive for medullary carcinoma of the right thyroid lobe (diameter 0.6 cm) in Hashimoto's thyroiditis. The association between thyroid cancers deriving from follicular cells and Hashimoto's thyroiditis is documented in the literature and would appear to determine a better prognosis. Cases such as the one presented in this paper, however, are rare and it is debated whether lymphocyte infiltration may predispose to the onset of medullary carcinoma or whether it is a defence against the tumour.     

Occult Papillary Thyroid Carcinoma: Diagnostic and Clinical Implications in the Era of Routine Ultrasonography

BACKGROUND: Papillary carcinoma with clinically apparent node metastasis but lacking a primary carcinoma lesion in the thyroid is designated as occult papillary carcinoma. In the era of routine ultrasonographic examination, occult papillary carcinoma is defined as papillary carcinoma with clinically apparent node metastasis but showing a primary lesion that is microscopic or overlooked by ultrasonography. In this study we investigated the prevalence and clinicopathologic features, including prognosis, of occult papillary carcinoma. METHODS: This is a retrospective series study of all patients with occult papillary thyroid carcinoma who underwent initial surgery at a single institution over 14 years. RESULTS: Between 1990 and 2004, 5400 patients underwent surgery for papillary thyroid carcinoma at Kuma Hospital, Japan. Seventeen (0.3%) were regarded as having occult papillary carcinoma and were enrolled in the study. Clinically apparent node metastasis was detected in the lateral compartment in 16 patients and in the mediastinal compartment in 1 patient. Multiple metastatic nodes were detected in 5 patients (29%). Primary lesions of papillary carcinoma were intraoperatively detected in 3 of 14 patients (21%) who underwent thyroidectomy, but there were no apparent carcinoma lesions in the thyroid in 5 patients (36%), even on pathologic examination. Six patients (35%) showed extranodal tumor extension to adjacent organs and two of these patients showed recurrence. None of the patients showed distant metastasis or died of carcinoma over the study period. CONCLUSIONS: Patients with occult papillary thyroid carcinoma were found to have a favorable overall prognosis. However, occult papillary carcinoma is automatically classified as N1b in the UICC classification, and in our series it is also likely to show other aggressive clinicopathologic features. In particular, extranodal tumor extension portends a worse prognosis for patients with occult papillary carcinoma. Therefore, careful total thyroidectomy with lymph node dissection is recommended except for elderly or high-risk patients.     

Renal cell carcinoma metastases to the thyroid gland -- report of 3 cases and review of the literature

Clinically significant, solitary metastasis to the thyroid gland is a rare occurrence. The clear cell carcinoma of the kidney (RCC) is the most common primary tumor site. Late recurrence is a notable feature of renal carcinoma. Solitary metastases in the thyroid gland occur as late as 100-120 months from the date of nephrectomy. There is a clear survival benefit in selected cases if surgical approach to the thyroid metastases is chosen. In those patients who have undergone complete resection, 5-year-survival-rates of 50 % have been reported. We describe 3 cases of surgically treated thyroid metastases of RCC, and review the literature.     

Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness

BACKGROUND: The effectiveness of minimally invasive video-assisted thyroidectomy (MIVAT) in papillary thyroid carcinoma is still debated. Some are concerned about this procedure in patients with thyroid cancer. This prospective study aimed to demonstrate that near-total thyroidectomy can be performed by MIVAT with similar results compared with open thyroidectomy. METHODS: A total of 33 patients with a thyroid nodule proven to be a papillary thyroid carcinoma underwent a near-total thyroidectomy. They were randomly assigned to group A (n = 16) or group B (n = 17) who were treated either by MIVAT or conventional near-total thyroidectomy, respectively. Iodine-131 thyroid bed uptake and serum thyroglobulin were measured 1 month after operation. Data were analyzed by unpaired t test and Mann-Whitney statistic methods. RESULTS: . Mean iodine-131 uptake was 5.1 +/- 4.9% in group A and 4.6 +/- 6.7% in group B. Mean thyroglobulin serum levels were 5.3 +/- 5.8 ng/mL in group A and 7.6 +/- 21.7 ng/mL in group B. The differences were not statistically significant. CONCLUSIONS: The results of this study showed that the completeness obtained with MIVAT is similar to that obtained with open thyroidectomy, with the great advantage of a minimal neck wound. No conclusions can be drawn in terms of influence of MIVAT on the outcome of the patients with small papillary thyroid carcinoma.     

桥本病合并甲状腺癌的诊治体会

目的 探讨桥本病合并甲状腺癌的诊断和治疗方法.方法 回顾分析74例桥本病合并甲状腺癌的临床资料.结果 2002年1月-2009年8月共收治252例桥本病,其中74例为桥本病合并甲状腺癌,均为乳头状癌,其中56例TGAb升高,68例MeAb升高,74例TPOAb升高.手术行患侧甲状腺全切除、峡部切除加对侧次全切除术45例,双侧甲状腺近全切除术1例(峡部癌).26例微小癌行甲状腺次全切除术或一侧腺叶全切除,2例双侧癌行双侧甲状腺全切除.所有病例同时行中央区淋巴结清扫,中央区淋巴结转移率20/74(27%).10例因患侧颈淋巴结转移行一侧颈部淋巴结改良清扫术.69例获得随访,随访时间1个月-7年,中位随访时间29个月.4例患者因发生一侧颈淋巴结转移而再次入院行改良颈淋巴清扫术. 结论'TGAb、McAb、B超、FNAB对术前诊断桥本病合并甲状腺癌有重要价值,手术应按甲状腺癌根治原则进行.     

A case of parathyroid carcinoma

A case of parathyroid carcinoma in a 49-year-old female is described. She is found to have renal stones and high serum calcium levels. On physical examination a fixed walnut-sized mass was detected on her right neck. Laboratory studies disclosed a serum calcium level of 12.7 mg/dl, serum phosphorus level of 2.5 mg/dl, serum Ca++ level of 3.12 mEq/l, and positive Gold-Smith test. Computer-assisted tomography scan and ultrasonogram showed a mass in the posterior region of the right lobe of her thyroid. The tumor was resected and histopathological examination showed parathyroid carcinoma. The patient had no evidence of recurrence 2 years following surgery. Our report is the 70th case among Japanese literature.     

年轻女性甲状腺癌的临床分析

目的探讨年轻女性甲状腺癌的临床特点,以期提高对该疾病的诊治水平。方法回顾性分析近10年连续收治的74例年轻甲状腺癌患者的临床资料,术前体检大多数甲状腺结节无质硬和固定的表现。术前患者均行B超检查,其中有61例患者(82.43%)B超示多发性结节;43例行同位素检查,有41例发现甲状腺结节,其中冷、凉和温结节分别为14,18,9例;11例行细针穿刺细胞活检,2例阴性,1例提示细胞有异型,3例提示癌疑,5例提示乳头状癌。结果病理检查70例为甲状腺乳头状癌,3例为滤泡状癌,1例为髓样癌,且大多数患者同时伴有其他甲状腺良性疾病;有28例(37.84%)出现颈部淋巴结转移,与同期中老年女性甲状腺癌颈淋巴结转移率16.46%(27/164)相比,差异有显著性(P<0.05)。有2例于术后3年内因远处转移而死亡。结论年轻女性甲状腺癌患者易发生淋巴结转移;结节的质地和活动度不应作为判断其良恶性的手段;应对B超发现的结节进行细化,对直径>1.0cm的实质性结节建议行手术治疗,对直径>2.0cm的混合性结节须行同位素和细针穿刺细胞活检检查,以免漏诊。     

Metastasis to the thyroid from lung adenocarcinoma mimicking thyroid carcinoma

We herein report a case of metastasis to the thyroid from lung adenocarcinoma mimicking thyroid carcinoma. The thyroid tumor was palpated in the left lobe of the thyroid and diagnosed as primary thyroid carcinoma by fine-needle aspiration cytology. The patient also had a large pulmonary tumor and tiny pulmonary nodules, which were respectively diagnosed as moderately differentiated adenocarcinoma of the lung and intrapulmonary metastases from the main large lung carcinoma by the pathological examination of the biopsy specimens obtained by video-assisted thoracic surgery. Hemithyroidectomy with radical neck dissection was performed. The thyroid tumor was diagnosed as metastasis to the thyroid from lung adenocarcinoma, because it showed mucin production, positive immunoreactivity for carcinoembryonic antigen and negative immunoreactivities for thyroglobulin and calcitonin. The patient received systemic chemotherapy and died of the disease 1 year and 7 months after the diagnosis was made.