An unusual case of papillary carcinoma of the thyroid with cutaneous and breast metastases only

Abstract

Cutaneous metastases of thyroid carcinoma are infrequent and, when present, are usually located in the vicinity of a widespread primary tumor. Breast metastases from these tumors are even less common. We report the case of a 64-year-old female with a toxic multinodular goiter in whom a fineneedle biopsy, performed in 1985 at the age of 52, was suggestive of papillary carcinoma of the thyroid. Total thyroidectomy for a papillary carcinoma, follicular variant, was performed in 1988. Four months after surgery, a cutaneous metastasis was discovered in the right thigh. Surgical excision of this lesion followed by treatment with radioactive iodine decreased serum Tg levels from 7495 to 3.3 mg/l. Under suppressive therapy with L-thyroxine, serum Tg remained undetectable for the next 4 years. Then, serum Tg levels rose to 3.9-5.6 mg/l and a second cutaneous metastasis was removed from the abdominal wall. The patient was again treated with radioactive iodine and the post-treatment wholebody scan did not show any area of increased uptake of the radionuclide. However, serum Tg levels under suppression with L-thyroxine remained elevated at 4-20 mg/l for the next 2 years. In August 1995, a 1.5 cm nodule was found in the right breast. Cytological examination was suggestive of a breast metastasis from thyroid carcinoma and the lesion was removed by enucleation. This proved to be a metastasis from a papillary carcinoma of the thyroid. Elevated (19-44 mg/l) serum Tg levels persisted postoperatively. A third cutaneous metastasis was revealed by 131 I scintigraphy in the right buttock and surgically removed in December 1996. Serum Tg levels have remained undetectable since then. To the best of our knowledge, this is a unique case of a papillary carcinoma of the thyroid with a propensity to metastasize only to the skin and breast during a follow-up of 11 years.

Primary breast carcinoma with features of the follicular variant of papillary thyroid carcinoma

“…To the best of our knowledge there are only six cases of metastatic PTC reported in the English literature. [4][5][6][7][8][9] PTC metastasis to the mammary gland is usually associated with disseminated disease. [3] Specifically, two cases of PTC follicular variant were found in the English literature exhibiting limited spreading.…”

“…The first showed three cutaneous lesions and one breast metastasis, identified through a period of 11 years without any evidence of local recurrence or other sites of dissemination. [5] The second presented with an isolated breast metastasis in a male patient [8] Clinical examination by itself offers little help to define whether a breast tumor is primary or metastatic since the later may manifest breast lump with axillary lymph node involvement. [10] In the present case the tumor revealed resemblance to the follicular variant of PTC with overall architecture and nuclear features suggestive of such.…”

“…[3] In the English literature few cases of PTC metastasizing to the breast have been reported. [4][5][6][7][8][9] Fixation is a complex series of chemical events that allow * Correspondence: Nektarios Koufopoulos; Email: koufonektar@yahoo.com; Address: Pathology Department, "Saint Savvas" Anti-Cancer Hospital, Athens, Greece.…”

Follicular Thyroid Carcinoma with Metastases to the Breast: An Unusual Case

“…Less common sites of metastases are the brain, liver, kidneys, and skin (1,2). Thyroid cancer metastasis to the breast was reported only in four cases and one of them was follicular sub-type (3)(4)(5)(6).…”

Cutaneous manifestations of thyroid cancer: a report of four cases and review of the literature

“…3 4 Rarely, papillary and follicular carcinomas spread haematogenously, involving lung, liver, bone, and occasionally brain. [5][6][7][8][9][10][11] Medullary carcinomas of the thyroid are neuroendocrine neoplasms originating from the parafollicular cells or C cells. These lesions also metastasise to locoregional lymph nodes, and spread haematogenously to affect liver and lungs.…”