Renal Metastasis from Follicular Thyroid Carcinoma Diagnosed by I-131 Whole-body Scan Mimicking Renal Cell Carcinoma on Contrast-Enhanced Computed Tomography

Cheon, Miju; Choi, Joon Young; Kim, Hee Kyung; Chung, Jae Hoon; Ko, Young Hyeh; Kim, Young Eun; Choi, Dongil; Lee, Kyung Han; Kim, Byung Tae

doi:10.1007/s13139-010-0067-3

Cited by 8 publications

(9 citation statements)

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“…As a general rule, when tumors metastasize to the kidney, the lesions are multifocal and often bilateral. However, several case reports exist of metastatic FTC presenting as a solitary renal mass [ 1 , 9 , 10 , 18 , 19 ]; these patients may present with flank pain and/or microscopic hematuria [ 1 , 7 , 18 ]. In patients with an established diagnosis of FTC, postthyroidectomy surveillance is performed by measurement of serum thyroglobulin levels, 131 I scintigraphy, and positron emission tomography (PET) using an 18 F-fluorodeoxyglucose- (FDG-) labeled tracer for detection of metastatic foci.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with an established diagnosis of FTC, postthyroidectomy surveillance is performed by measurement of serum thyroglobulin levels, 131 I scintigraphy, and positron emission tomography (PET) using an 18 F-fluorodeoxyglucose- (FDG-) labeled tracer for detection of metastatic foci. Case reports exist of renal metastases of FTC detected by a rise in serum thyroglobulin, areas of increased 131 I uptake, or FDG-avid foci on PET indicating increased metabolic activity [ 1 , 9 , 10 , 17 ], in addition to the presence of a mass on conventional or contrast-enhanced CT. It is not unheard of for patients to present with metastases a decade or more after thyroidectomy [ 7 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is not unheard of for patients to present with metastases a decade or more after thyroidectomy [ 7 , 18 , 19 ]. Treatment of metastatic FTC consists of total thyroidectomy, regional lymph node dissection, surgical resection of the metastatic foci with clear margins, and 131 I radioablative therapy for removal of any residual disease or micrometastases [ 1 , 8 – 10 , 19 ]. Levothyroxine is also given, with the intent of both replacing thyroid hormone and suppressing thyroid-stimulating hormone levels [ 9 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Follicular Thyroid Carcinoma Metastatic to the Kidney: Report of a Case with Cytohistologic Correlation

Nath

Baliga

Lewin

et al. 2015

Case Reports in Pathology

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Here we report a case of a 45-year-old female who underwent thyroidectomy for thyroid cancer and presented 20 years later with a left renal mass. CT-guided core biopsy was performed, and imprints and histologic sections of the biopsy showed cells resembling thyroid follicular cells with a background containing colloid. Immunohistochemistry revealed positivity for thyroglobulin and thyroid transcription factor 1, consistent with metastatic follicular thyroid carcinoma (FTC). The patient later underwent radical nephrectomy; histologic sections of the resected tumor revealed an encapsulated lesion morphologically similar to the biopsy specimen. Thyroid metastases to the kidney are extremely rare and are often detected during postthyroidectomy surveillance by elevation in thyroid hormone levels, 131I scintigraphy, or 18F-fluorodeoxyglucose uptake in positron emission tomography studies. Treatment involves total thyroidectomy, resection of the metastatic foci, and 131I therapy. The differential diagnoses of renal metastasis of FTC include the encapsulated follicular variant of papillary thyroid carcinoma (PTC), which possesses some of the nuclear features seen in conventional PTC but may occasionally be indistinguishable from FTC in cytologic preparations, and renal lesions such as benign thyroidization of the kidney and thyroid-like follicular carcinoma of the kidney, which mimic FTC in histologic appearance but do not stain with thyroid markers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Follicular Thyroid Carcinoma Metastatic to the Kidney: Report of a Case with Cytohistologic Correlation

Nath

Baliga

Lewin

et al. 2015

Case Reports in Pathology

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“…NIS, a transmembrane glycoprotein, mediates uptake of iodide into the follicular cells of the thyroid gland in the synthesis of thyroid hormone [ 7 ]. Other possible reasons are: inability of the magnetic resonance imaging (MRI) to differentiate between the renal metastases and solid kidney tumors (since metastatic lesions usually appear isointense with surrounding tissue on T1-weighted images of MRI) [ 11 ]; misinterpretation of iodine-131 scan in the abdomen as physiological uptake [ 7 ]; and low diagnostic yield of routine imaging modalities such as CT or US [ 12 ]. Moreover, metastases to the kidney occur very late due to the indolent nature of thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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“… 27 Of the 21 cases of renal metastasis associated with differentiated thyroid carcinoma (DTC), 9 were from papillary carcinoma (6 were follicular-variant papillary carcinomas) and 12 were from follicular carcinoma. 28 TLFCK usually presents as a solitary tumor, but the majority of thyroid carcinoma metastases to the kidney are widely disseminated. More importantly, metastatic thyroid carcinoma is immunoreactive for TTF-1 and TG, but TLFCK is not.…”

Section: Clinicopathologic Featuresmentioning

confidence: 99%

Thyroid-Like Follicular Carcinoma of the Kidney in a Patient with Skull and Meningeal Metastasis

Dong

Huang

et al. 2016

Medicine

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Thyroid-like follicular carcinoma of the kidney (TLFCK) is an extremely rare subtype of renal cell carcinoma with close resemblance to the well-differentiated thyroid follicular neoplasms. TLFCK has not been included in the 2004 World Health Organization (WHO) classification due to the limited data available. Only 27 cases have been reported in the literature to date.Herein, we report a unique case of TLFCK that presented as a striking skull and meningeal metastasis 5 years after the initial diagnosis; this is the first case of TLFCK with such a novel metastasis pattern. A 68-year-old woman was found to have a right renal lesion using computed tomography (CT) during her regular clinical follow-up visit for bladder cancer, but she exhibited no obvious clinical symptoms. The CT scan showed a 4.4-cm diameter, slightly lobulated soft tissue mass in the right lower kidney, the pathological findings of which showed a TLFCK. Five years later, the patient had progressed to skull and meningeal metastasis.Both the renal tumor and the metastasis lesion were composed almost entirely of follicles with a dense, colloid-like material that resembled thyroid follicular carcinoma. However, no lesion was found in the thyroid gland. The neoplastic epithelial cells were strongly immunoreactive for cytokeratin 7 (and vimentin but negative for thyroid transcription factor-1 and thyroglobulin.This is the first reported case of TLFCK to consist of widespread metastases to the skull and meninges and provides evidence that this rare variant of renal cell carcinoma has uncertain malignant potential and can be more clinically aggressive than previously believed.

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Renal Metastasis from Follicular Thyroid Carcinoma Diagnosed by I-131 Whole-body Scan Mimicking Renal Cell Carcinoma on Contrast-Enhanced Computed Tomography

Cited by 8 publications

References 10 publications

Follicular Thyroid Carcinoma Metastatic to the Kidney: Report of a Case with Cytohistologic Correlation

Follicular Thyroid Carcinoma Metastatic to the Kidney: Report of a Case with Cytohistologic Correlation

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

Thyroid-Like Follicular Carcinoma of the Kidney in a Patient with Skull and Meningeal Metastasis

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