It is no longer the time to disregard thyroid metastases from breast cancer: a case report and review of the literature

Abstract

BackgroundMetastases to the thyroid gland are more frequent than previously thought, although most of them are occult or not clinically relevant. Overall, only 42 cases of metastases to thyroid from breast cancer have been reported thus far. Here we report the case of a patient with breast cancer metastatic to the thyroid. We also review the 42 previously reported cases (published between 1962 and 2012). This is the first review about metastases to thyroid gland from breast cancer.Case presentationA 64-year-old woman of Caucasian origin was diagnosed with a lobular invasive carcinoma of the breast (luminal A, stage II). She received adjuvant chemotherapy, followed by endocrine therapy. During follow-up, fine-needle cytology of a thyroid nodule revealed malignant cells that were estrogen-positive, which suggested a diagnosis of metastases to the thyroid. Imaging did not reveal any other metastatic site and showed only enlargement of the left thyroid lobe and an inhomogeneous pattern of colloid and cystic degeneration and calcifications. The patient underwent left hemithyroidectomy. Histology of thyroid tissue showed a colloid goitre containing dispersed small atypical neoplastic cells with eccentric nuclei. Immunohistochemistry showed cytokeratin-19 and oestrogen receptor, but not tireoglobulin, e-cadherin or cytokeratin-7, thereby confirming metastases from a lobular breast carcinoma. Hormonal treatment is ongoing.ConclusionThis case report and first review of the literature on metastases to thyroid from breast cancer highlight the importance of a correct early diagnostic work-up in such cases. Indeed, a primary lesion should be distinguished from metastases given the different treatment protocol related to primary cancer and the clinical impact on prognosis.

Thyroid metastases from breast carcinoma: case report and review of literature

“…Some studies reported that patients with thyroid metastases from breast cancer were symptomless and presented malignant thyroid nodules by ultrasound [1,3]. Similar clinical manifestations were reported by Owens et al [11] and Pensabene et al [4]. In our case, the patient also presented no symptoms related to the thyroid disease.…”

“…In addition,the US features of thyroid metastases from breast cancer are not speci c. Zhou et al [1] reported that six patients showed heterogeneous echogenicity with scattered microcalci cation, and two patients had hypoechoic solid nodule on US. Pensabene et al [4] reported that one case showed enlarged thyroid with thyroid nodules on US. Similar thyroid nodule on US was reported by Magers et al [6], Lacka et al [7] and Owens et al [11].…”

“…Cytologic examination using FNAB is highly sensitive and speci c in demonstrating a malignant thyroid nodule. But it is sometimes di cult to show the origin of the metastatic cancer [4]. Owens et al [11] reported that FNAB of thyroid metastases from breast cancer demonstrated malignant epithelial cells with enlarged nuclei and irregular nuclear contours, but in the absence of intranuclear grooves and pseudoinclusions.…”

“…Thyroidectomy was recommended for isolated thyroid metastases from breast carcinomas [10]. Other cases suggested that thyroidectomy has no e cacy in patients with thyroid metastases from breast cancer combined with multiple distant metastases and chemotherapies should be performed [1,4]. With the limitation of the small number of patient data, there is no de nitive evidence to support surgery or chemotherapy or radiotherapy for thyroid metastases from breast cancer [4].…”

“…It is well known that the most frequent distant metastases of breast cancer are bone and visceral organs [3]. Generally,the common origins of thyroid metastases seems to be breast cancer and lung cancer in autopsy cases [4]. However, in clinical cases, the most common primary site is the kidney, followed by the breast [5,6].…”