Cutaneous metastasis of Papillary thyroid carcinoma to the neck: a case report and review of the literature

Abstract

Papillary thyroid carcinoma, the most common subtype of thyroid malignancy, rarely presents with cutaneous metastasis. Despite metastatic cutaneous lesions presenting as slow and indolent growing nodules of the head and neck, such lesions most frequently appear in the setting of diffuse and dramatic metastatic disease and portend a bleak prognosis. Given the rarity of these metastases, the diagnosis may be delayed and often the initial diagnosis is incorrect. Several case reports have been published in the literature noting unusual or interesting presentations of thyroid carcinoma with cutaneous metastasis. Herein we present a patient with a prior diagnosis of thyroid carcinoma presenting with a slowly growing ulcerated nodule on the neck nine years after partial thyroidectomy. Characteristic histopathology was found on microscopic examination. In addition, we review the literature regarding papillary thyroid carcinoma with cutaneous metastasis and the diagnostic challenge these lesions present to practitioners.

Skin Metastasis Occurring 30 Years After Thyroidectomy for Papillary Thyroid Carcinoma

“…The skin is a very rare site of metastatic involvement in PTC; there are only a few case reports in the English literature to date (Table 1) [3][4][5][7][8][9][10][11][12][13][14][15][16][17]. Skin metastasis might manifest as a pimple, slowly growing nodule, or rarely bleeding ulcer [16]. The median onset of skin metastasis from initial treatment for primary PTC was 8.25 years (range: 1-21 years), as shown in Table 1.…”

“…Numerous mechanisms for the eventuality of skin metastasis from PTC have been postulated, including direct extension, hematogenous spread, lymphatic spread, and the implantation of exfoliated tumor cells during biopsy or thyroidectomy scars [12]. The majority of skin metastases are located in the scalp, face, and neck, which may be explained by the rich lymphatics and/or vascular supply of these regions that confine the cancer cell emboli from the circulation and provide a microenvironment for the successful proliferation of metastatic foci [16].…”

PD-L1-positive Anaplastic Transformation in a BRAF V600E Expressing Papillary Thyroid Carcinoma with Cutaneous Metastasis: An Unusual Case Report

“…Cutaneous metastasis is a rare manifestation of visceral malignancies, the most common primary being breast cancers, and may mimic skin adnexal cancers. 1,2 Thyroid carcinoma with cutaneous metastasis usually occurs in association with diffuse diseases and typically is associated with a poor prognosis. 1 Cutaneous metastasis from anaplastic thyroid carcinomas is even rarer with only a handful of cases reported so far.…”

“…1,2 Thyroid carcinoma with cutaneous metastasis usually occurs in association with diffuse diseases and typically is associated with a poor prognosis. 1 Cutaneous metastasis from anaplastic thyroid carcinomas is even rarer with only a handful of cases reported so far. 3 Most commonly, cutaneous metastasis from a thyroid carcinoma develops in the scalp region.…”

“…3 Most commonly, cutaneous metastasis from a thyroid carcinoma develops in the scalp region. 1,4 We present an interesting case of anaplastic transformation in PTC associated with cutaneous metastasis in the thoracic region. We present the following case in accordance with the CARE reporting checklist (available at http://dx.doi.org/10.21037/gs-20-845).…”