Follicular Variant of Papillary Thyroid Cancer with Bilateral Renal Metastases Discovered Incidentally During Work-Up of Primary Endometrial Cancer: A Rare Occurrence

Abstract

Patient: Female, 70Final Diagnosis: Follicular variant of papillary thyroid cancer with renal metastasesSymptoms: Bleeding per vaginumMedication: —Clinical Procedure: Total thyroidectomySpecialty: OncologyObjective:Rare diseaseBackground:Follicular variant of papillary thyroid cancer (FV-PTC) is the second most common subtype of papillary thyroid cancer (PTC) after classic PTC. FV-PTC is characterized by nuclear features consistent with classic PTC but has a follicular architecture that lacks classic papillary morphology. Thyroid cancer rarely metastasizes to the kidney. Only 6 cases of FV-PTC metastasizing to the kidney have been reported in the English literature. We are reporting a case of FV-PTC with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer.Case Report:A 70-year-old woman presented with post-menopausal bleeding secondary to endometrial cancer. Staging work-up showed multiple bilateral lung nodules, bilateral soft tissue kidney masses, and multinodular goiter. The pathological and immnohistochemical profile of the lung biopsy was consistent with primary well-differentiated lung adenocarcinoma. Follow-up computerized tomography scan showed stable lung nodules and enlarging renal masses, which was suggestive of bilateral renal cancer. While the histologic features of the renal biopsy were not typical, the immunohistochemical staining of renal biopsy was positive for Paired box 8, thyroid transcription factor-1, thyroglobulin, and cytokeratin 7, suggesting the thyroid as the primary cancer site. The final histopathology on surgical specimen of total thyroidectomy revealed follicular variant of papillary thyroid cancer.Conclusions:The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites. The clinician should be aware of the possibility of metastasis and look for the primary source, which in the present case was FV-PTC. Immunohistochemistry plays an important role in determining the primary site of origin. In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

Diagnostic Value of Conventional Ultrasonography Combined with Contrast-Enhanced Ultrasonography in Thyroid Imaging Reporting and Data System (TI-RADS) 3 and 4 Thyroid Micronodules

“…Our results were further enhanced by the use of both logistic regression analysis and ROC curve. Although data show that the incidence of PTC has been decreasing significantly and the prognosis for this disease has greatly improved, the early detection on this disease still needs to be emphasized because it easily spreads to the lungs and bones [ 20 – 22 ]., Our study investigated the diagnostic value of conventional US combined with CEUS in TI-RADS 3 and 4 thyroid micronodules.…”

Analysis of Risk Factors Contributing to Recurrence of Papillary Thyroid Carcinoma in Chinese Patients Who Underwent Total Thyroidectomy

“…Several studies have shown that lymph node metastasis is observed in approximately 7.1–79.0% of patients with PTC [ 7 , 21 , 23 , 38 ], and there can be cervical lymph node metastases in up to 80% of patients [ 13 , 39 , 40 ]. This study indicated that the proportion of lymph node metastasis detected was 64.8%, which is similar to the previous results on PTC after curative resection.…”

Renal metastasis from papillary carcinoma thyroid detected by whole body iodine scan: A case report and review of the literature

“…However, any abnormal uptake in abdomen other than the physiological gastrointestinal uptake also requires radiological correlation. 13 …”