Clavicular Metastasis of Insular Carcinoma of the Thyroid Showing Increased Uptake in the Presence of a Functioning Thyroid Gland

Bose, Smarajit; Ravindra, Nannapaneni; Girdhar, Govindraj; Bhattacharya, Ashish K.

doi:10.1097/00003072-199811000-00013

Cited by 11 publications

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“…Most insular carcinomas of the thyroid take up a large amount of iodine and generate thyroglobulin [19, 22, 23]. Accordingly, most researchers recommend treatment with 131 I as a postoperative adjuvant treatment or to control distant metastases [8, 9, 13, 16, 17, 19].…”

Section: Discussionmentioning

confidence: 99%

Insular Carcinoma: Infrequent Subtype of Thyroid Cancer with Aggressive Clinical Course

2004

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Data on four male and four female patients with insular carcinoma of the thyroid were reviewed to elucidate the clinical characteristics of this malignancy. The median age of the patients was 62.5 years (range 29-78 years). The size of the tumors ranged from 3.0 to 10.0 cm (median 4.7 cm). One patient with extensive neck disease and distant metastases underwent palliative debulking of the tumor mass and died of respiratory failure 10 days after surgery. Seven patients underwent total thyroidectomy. In addition to being given thyroxine supplement, three patients were treated with postoperative iodine-131 ((131)I) therapy, two with external radiation after (131)I treatment, and two with external radiation. Local invasion of the malignancy into strap muscles was observed in two patients, into the trachea in two patients, into the recurrent laryngeal nerve in one patient, and into the internal jugular vein in one patient. The median follow-up was 26 months (range 3-80 months). Lung metastases occurred in four patients and metastases at the neck lymph nodes in four patients; recurrence at the thyroid bed was observed in one patient. Four patients died of distant metastases and progressive recurrent disease. Of the three surviving patients, two remained disease-free, and one remained alive with lung metastases. In conclusion, insular carcinomas behave aggressively, so we believe they should be treated by total thyroidectomy plus neck dissection when nodal metastases are present.

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Section: Discussionmentioning

confidence: 99%

Insular Carcinoma: Infrequent Subtype of Thyroid Cancer with Aggressive Clinical Course

2004

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“…Many authors have reported a high aggressiveness and mortality rate in these tumors, although others have not evidenced a poor prognosis in patients who have tumors with a minor insular component 20. Moreover, it has been emphasized that insular carcinomas have high iodine uptake and produce Tg, both typical features of the normal thyroid cell and of well‐differentiated thyroid carcinomas 24–28. Because of the relatively rarity of this histotype, many reports included only small numbers of patients and made no direct comparison with patients who had noninsular, differentiated carcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…Insular thyroid carcinomas usually maintain some of the functional characteristics of the follicular thyroid cells, such as iodine uptake and thyroglobulin (Tg) production. Therefore, when their tumors become metastatic, patients with these tumors can be treated with radioiodine, like patients with well‐differentiated thyroid tumors 24–28. However, it has not been established whether patients who have insular carcinoma should be managed more aggressively compared with patients who have papillary/follicular carcinoma.…”

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Long‐term outcome of patients with insular carcinoma of the thyroid

Pellegriti

Giuffrida²,

Scollo

et al. 2002

Cancer

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BACKGROUND Insular thyroid carcinoma was described originally as a tumor with aggressive behavior. However, whether a predominant insular component is an independent factor for poor prognosis is unclear. METHODS The authors compared the clinical behavior of tumors in three groups of patients with thyroid carcinoma—13 patients with insular thyroid carcinoma, 18 patients with follicular thyroid carcinoma, and 26 patients with papillary thyroid carcinoma—who were selected based on similar tumor size and similar age. Disease free survival and disease specific deaths were assessed in the three groups with a Kaplan–Meier analysis and were compared using the log‐rank test. Cox regression analysis was used to evaluate the influence of histotype and other prognostic factors on the occurrence of distant metastases and disease specific death. RESULTS Patient follow‐up ranged from 5.2 months to 190.0 months. At last follow‐up, only 1 of 13 patients (7.7%) with insular carcinoma, compared with 8 of 18 patients (44.4%) with follicular carcinoma and 12 of 26 patients (46.1%) with papillary carcinoma, were disease free. The disease specific death rate was 61.5% among patients in the insular carcinoma group compared with 16.7% and 15.4% among patients in the follicular carcinoma group (P = 0.006) and the papillary carcinoma group (P = 0.025), respectively. At multivariate analysis, the insular histotype was the only variable that was related independently to disease specific death (hazard ratio = 4.27; P = 0.005). Distant metastases occurred in 84.6% of patients in the insular carcinoma group compared with 50% and 19.2% of patients in the follicular carcinoma group (P = 0.039) and the papillary carcinoma group (P = 0.0003), respectively. All metastases from patients with insular carcinomas (n = 11 patients) showed radioiodine uptake, but a clinical benefit from this treatment was observed only in 1 patient. CONCLUSIONS Patients with insular thyroid carcinoma have a poorer outcome compared with patients of similar age who have differentiated types of thyroid carcinoma with tumors of a similar size. Because radioiodine rarely is effective in the treatment of patients with metastatic insular thyroid carcinoma, novel and possible multimodal therapies should be explored for the treatment of patients with these aggressive tumors. Cancer 2002;95:2076–85. © 2002 American Cancer Society. DOI 10.1002/cncr.10947

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“…There is no consensus that all insular cancers and their metastases trap iodine. However, there are reports of distant metastases, including skeletal metastases demonstrating uptake [561,562]. When the cancer is locally invasive and it appears from diagnostic and post therapy scintigraphy with radioiodine that the extent of disease imaged is an under-estimation of the disease expected, external radiation should be prescribed.…”

Section: Managementmentioning

confidence: 99%

Differentiated Thyroid Cancer

Management of Thyroid Cancer and Related Nodular Disease

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Clavicular Metastasis of Insular Carcinoma of the Thyroid Showing Increased Uptake in the Presence of a Functioning Thyroid Gland

Cited by 11 publications

References 1 publication

Insular Carcinoma: Infrequent Subtype of Thyroid Cancer with Aggressive Clinical Course

Insular Carcinoma: Infrequent Subtype of Thyroid Cancer with Aggressive Clinical Course

Long‐term outcome of patients with insular carcinoma of the thyroid

Differentiated Thyroid Cancer

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