Papillary thyroid carcinoma with maxillary metastasis

Abstract

Introduction:The incidence of distant metastasis in papillary thyroid carcinoma (PTC) is less than5%. Most such metastases occur in the lungs and bones. More than 80% of bone metastases are located in the axial skeleton. Metastasis to the facial bones is extremely rare.Patient concerns: A 36-year-old man presented with intermittent attacks of epistaxis, nasal obstruction, right-sided facial swelling, and a progressive headache without fever or preceding dental trauma. He had undergone total thyroidectomy with neck dissection for PTC in 2017.Diagnosis: Computed axial tomography and magnetic resonance imaging of the head and neck region showed a well-defined mass occupying the right maxillary sinus with bony erosion, measuring approximately 5.8 Â 3.2 Â 5.3 cm. Biopsy revealed metastatic PTC, which was confirmed using immunohistochemistry. Interventions:The patient underwent debulking surgery in the form of partial maxillectomy and reconstruction of the mucosal defect using a buccal pad of fat. A post operative therapeutic dose of radioactive iodine (TDRI) was administered.Outcomes: A whole-body iodine scan performed 5 days after the dose revealed multiple metastases affecting the right maxilla, both lungs, and left tibia. The patient was discharged on the fifth day following TDRI and resumed thyroid suppressive therapy. The patient was scheduled for another TDRI six months later. Conclusion:Maxilla metastasis of PTC is rare, usually occurs in women, and is usually associated with other metastases. When maxillary bone metastasis occurs, physicians, dentists, and pathologists should not exclude the possibility of metastatic PTC.