Endocrine DOI 10.1007/s12020-014-0258-2
LETTER TO THE EDITOR
Precocious and isolated thyroid metastasis of colorectal adenocarcinoma and incidental thyroid papillary microcarcinoma T. Amenduni • A. Carbone • R. Bruno
Received: 25 February 2014 / Accepted: 25 March 2014 Ó Springer Science+Business Media New York 2014
To the editor Metastases of nonthyroid malignancies to the thyroid gland are found to be a rare occurrence. They have been reported in only 1.4–3 % of all the patients who underwent surgery for suspected cancer in the thyroid gland [1]. We report the case of a 63-year-old woman who was referred to our endocrine unit for an incidentally discovered multinodular goiter during the follow-up of a colorectal adenocarcinoma. She had been treated with left hemicolectomy and chemotherapy two years earlier. She was diabetic on insulin therapy and hypertese. Clinical examination revealed an evident anterolateral cervical swelling on the right side of her neck with dyspnoea in clinostatism. She was euthyroid; antithyroglobulin autoantibodies and antithyroid peroxidase autoantibodies were absent. Calcitonin levels were in the normal range. The ultrasound imaging showed an enlarged multinodular thyroid gland particularly at the expense of the right lobe. The radiological examination and TC demonstrated tracheal deviation and compression. No other suspected lesion was present at the imaging. Due to dyspnoea and the apparent nonprogression of the malignant disease, total thyroidectomy was performed. Pathology revealed a colorectal adenocarcinoma metastasis in the right thyroid lobe and an incidental concomitant focus of (diameter 2 mm) papillary microcarcinoma (follicular variant) in the same lobe (Fig. 1). Kidney, colorectal, lung, and breast are potential sources of nonthyroid cancers that metastasize to the thyroid. Older autopsies’ studies report a wide range of frequencies from T. Amenduni A. Carbone R. Bruno (&) Tinchi Hospital, Pisticci, Matera, Italy e-mail: [email protected]
1.9 to 24 % [2]. This event is more frequent in abnormal thyroid glands compared with normal glands. Metastases were the most commonly found concomitantly with goiters and follicular thyroid adenomas. Our patient was euthyroid at diagnosis, but hypothyroidism and thyrotoxicosis can occur due to the infiltration of the gland by the malignant mass and leakage of the hormones into the peripheral blood resulting from damage to the thyroid by neoplastic embolization, respectively. In general, thyroid metastases can present many years after the initial diagnosis (mean interval 5.8 years), making diagnosis even more difficult [3]. In this case, thyroid metastases occurred 2 years after the first diagnosis, and no other sites of metastases have been found with the TC imaging. Although thyroid gland is a rare site for clinically significant tumor metastases, this possibility should be kept in mind while treating patients with a previous history of malignancy. This is particularly important if we come across the presence of a rapidly growing thyroid mass, enlarged thyroid gland, neck swelling, dysphagia, dysphonia, and cough [3]. Metastases to thyroid gland should also be considered in patient with a history of malignancy and thyroid nodule FNAB nondiagnostic or equivocal. Finally, the possibility of the association of thyroid carcinoma with other malignancy should also be considered as a part of a syndrome such as Familial Adenomatous Polyposis, Cowden’s Syndrome and Peutz–Jeghers Syndromes, characterized by the development of polyps/cancer of the gastrointestinal tract and malignancy in different sites. For this reason, it is extremely important to know the primary localization of the malignancy to correctly address the pathologist in the differential diagnosis of the thyroid lesion. Finally, our observation suggests that metastasis to thyroid should always be considered in the differential
123
Endocrine
Fig. 1 Thyroid papillary microcarcinoma (left) colorectal cancer metastasis to thyroid (right)
diagnosis of thyroid lesions in patients with a history of cancer elsewhere, also in the short follow-up, particularly if thyroid abnormalities are present at the time of the first diagnosis because of the higher frequency of metastases in the diseased thyroid gland.
Conflict of interest interest.
123
All authors state that they have no conflicts of
References 1. G. Papi, G. Fadda, S.M. Corsello, S. Corrado, E.D. Rossi, E. Radighieri, A. Miraglia, C. Carani, A. Pontecorvi, Metastases to thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin. Endocrinol. 66, 565–571 (2007) 2. K. Wood, L. Vini, C. Harmer, Metastases to the thyroid gland: the Royal Marsden experience. Eur. J. Surg. Oncol. 30, 583–588 (2004) 3. A.Y. Chung, T.B. Tran, K.T. Brumund, R.A. Weisman, M. Bouvet, Metastases to the thyroid: a review of the literature from the last decade. Thyroid 22, 258–268 (2012)
LETTER TO THE EDITOR
Precocious and isolated thyroid metastasis of colorectal adenocarcinoma and incidental thyroid papillary microcarcinoma T. Amenduni • A. Carbone • R. Bruno
Received: 25 February 2014 / Accepted: 25 March 2014 Ó Springer Science+Business Media New York 2014
To the editor Metastases of nonthyroid malignancies to the thyroid gland are found to be a rare occurrence. They have been reported in only 1.4–3 % of all the patients who underwent surgery for suspected cancer in the thyroid gland [1]. We report the case of a 63-year-old woman who was referred to our endocrine unit for an incidentally discovered multinodular goiter during the follow-up of a colorectal adenocarcinoma. She had been treated with left hemicolectomy and chemotherapy two years earlier. She was diabetic on insulin therapy and hypertese. Clinical examination revealed an evident anterolateral cervical swelling on the right side of her neck with dyspnoea in clinostatism. She was euthyroid; antithyroglobulin autoantibodies and antithyroid peroxidase autoantibodies were absent. Calcitonin levels were in the normal range. The ultrasound imaging showed an enlarged multinodular thyroid gland particularly at the expense of the right lobe. The radiological examination and TC demonstrated tracheal deviation and compression. No other suspected lesion was present at the imaging. Due to dyspnoea and the apparent nonprogression of the malignant disease, total thyroidectomy was performed. Pathology revealed a colorectal adenocarcinoma metastasis in the right thyroid lobe and an incidental concomitant focus of (diameter 2 mm) papillary microcarcinoma (follicular variant) in the same lobe (Fig. 1). Kidney, colorectal, lung, and breast are potential sources of nonthyroid cancers that metastasize to the thyroid. Older autopsies’ studies report a wide range of frequencies from T. Amenduni A. Carbone R. Bruno (&) Tinchi Hospital, Pisticci, Matera, Italy e-mail: [email protected]
1.9 to 24 % [2]. This event is more frequent in abnormal thyroid glands compared with normal glands. Metastases were the most commonly found concomitantly with goiters and follicular thyroid adenomas. Our patient was euthyroid at diagnosis, but hypothyroidism and thyrotoxicosis can occur due to the infiltration of the gland by the malignant mass and leakage of the hormones into the peripheral blood resulting from damage to the thyroid by neoplastic embolization, respectively. In general, thyroid metastases can present many years after the initial diagnosis (mean interval 5.8 years), making diagnosis even more difficult [3]. In this case, thyroid metastases occurred 2 years after the first diagnosis, and no other sites of metastases have been found with the TC imaging. Although thyroid gland is a rare site for clinically significant tumor metastases, this possibility should be kept in mind while treating patients with a previous history of malignancy. This is particularly important if we come across the presence of a rapidly growing thyroid mass, enlarged thyroid gland, neck swelling, dysphagia, dysphonia, and cough [3]. Metastases to thyroid gland should also be considered in patient with a history of malignancy and thyroid nodule FNAB nondiagnostic or equivocal. Finally, the possibility of the association of thyroid carcinoma with other malignancy should also be considered as a part of a syndrome such as Familial Adenomatous Polyposis, Cowden’s Syndrome and Peutz–Jeghers Syndromes, characterized by the development of polyps/cancer of the gastrointestinal tract and malignancy in different sites. For this reason, it is extremely important to know the primary localization of the malignancy to correctly address the pathologist in the differential diagnosis of the thyroid lesion. Finally, our observation suggests that metastasis to thyroid should always be considered in the differential
123
Endocrine
Fig. 1 Thyroid papillary microcarcinoma (left) colorectal cancer metastasis to thyroid (right)
diagnosis of thyroid lesions in patients with a history of cancer elsewhere, also in the short follow-up, particularly if thyroid abnormalities are present at the time of the first diagnosis because of the higher frequency of metastases in the diseased thyroid gland.
Conflict of interest interest.
123
All authors state that they have no conflicts of
References 1. G. Papi, G. Fadda, S.M. Corsello, S. Corrado, E.D. Rossi, E. Radighieri, A. Miraglia, C. Carani, A. Pontecorvi, Metastases to thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin. Endocrinol. 66, 565–571 (2007) 2. K. Wood, L. Vini, C. Harmer, Metastases to the thyroid gland: the Royal Marsden experience. Eur. J. Surg. Oncol. 30, 583–588 (2004) 3. A.Y. Chung, T.B. Tran, K.T. Brumund, R.A. Weisman, M. Bouvet, Metastases to the thyroid: a review of the literature from the last decade. Thyroid 22, 258–268 (2012)
