Synchronous Sternal Metastasectomy and Total Thyroidectomy for Differentiated Thyroid Cancer: A Rare Case Report

Πασπάλα, Άννα; Papakonstantinou, Dimitrios; Pikoulis, Emmanouil; Tomos, Periklis; Nastos, Constantinos

doi:10.7759/cureus.31294

Cited by 4 publications

(10 citation statements)

References 19 publications

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“…Similarly, one case from 2022 involved the diagnosis of a papillary thyroid carcinoma associated with an anterior mediastinal metastatic mass including the sternum (from the notch to the third intercostal space) that required a total thyroid removal and en bloc resection of the sternum metastasis, followed by radioiodine therapy. Stability of the disease was achieved for the following 8 months [ 32 ].…”

Section: Results: Sternal Metastases—a Multidisciplinary Perspective ...mentioning

confidence: 99%

“… Overview of published case reports (N = 34) according to our methods [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 30 , 32 , 33 , 37 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ]. Abbreviations: N = number of patients; MiNEN = mixed neuroendocrine–non-neuroendocrine tumour.…”

Section: Figurementioning

confidence: 99%

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Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

Carsote,

Terzea,

Vasilescu

et al. 2023

Diagnostics

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We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as “sternal”, “manubrium”, and “metastasis” within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisional biopsy was used to address a 10 cm sternal tumour upon first admission on an apparently healthy male). The studies (n = 14) may be classified into one of three groups: studies addressing the incidence of bone metastases (including sternum) amid different primary cancers, such as prostate cancer (N = 122 with bone metastases, 83% of them with chest wall metastases), head and neck cancers (N = 3620, 0.8% with bone metastases, and 10.34% of this subgroup with sternum involvement); and glioblastoma (N = 92 with bone metastases, 37% of them with non-vertebral metastases, including the sternum); assessment cohorts, including breast cancer (N = 410; accuracy and sensitivity of PET/CT vs. bone scintigraphy is superior with concern to sternum spreading) and bone metastases of unknown origin (N = 83, including a subgroup with sternum metastases; some features of PET/CT help the differentiation with multiple myeloma); and cohorts with various therapeutic approaches, such as palliative arterial embolization (N = 10), thymic neuroendocrine neoplasia (1/5 detected with sternum metastases), survival rates for sternum metastases vs. non-sternum chest wall involvement (N = 87), oligo-metastatic (sternal) breast cancer (3 studies, N = 16 for all of them), oligo-metastatic head and neck cancer (N = 81), conformal radiotherapy (N = 24,215, including an analysis on sternum spreading), and EBRT followed by MR-HIFU (N = 6). Core data coming from the isolated case reports (N = 34) showed a female to male ratio of 1.6; the females’ ages were between 34 and 80 (mean of 57.28) and the males’ ages varied between 33 and 79 (average of 58.78) years. The originating tumour profile revealed that the most frequent types were mammary (N = 8, all females) and thyroid (N = 9, both women and men), followed by bladder (N = 3), lung (N = 2), and kidney (N = 2). There was also one case for each of the following: adenoid cystic carcinoma of the jaw, malignant melanoma, caecum MiNEN, a brain and an extracranial meningioma, tongue carcinoma, cholangiocarcinoma, osteosarcoma, and hepatocellular carcinoma. To our knowledge, this is the most complex and the largest analysis of prior published data within the time frame of our methods. These data open up new perspectives of this intricate, dynamic, and challenging domain of sternum metastases. Awareness is a mandatory factor since the patients may have a complex multidisciplinary medical and/or surgical background or they are admitted for the first time with this condition; thus, the convolute puzzle will start from this newly detected sternal lump. Abbreviations: N = number of patients; n = number of studies; PET/CT = positron emission tomography/computed tomography; EVRT = external beam radiotherapy; MR-HIFU = magnetic resonance-guided high-intensity focused ultrasound; MiNEN = mixed neuroendocrine-non-neuroendocrine tumour.

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Section: Results: Sternal Metastases—a Multidisciplinary Perspective ...mentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

Carsote,

Terzea,

Vasilescu

et al. 2023

Diagnostics

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“…These considerations encompass assessing the risk of fractures, the potential for neurologic compromise, the presence of pain, the extent of RAI uptake, and the potential for significant marrow exposure arising from radiation associated with RAI-avid pelvic metastases. These criteria serve as valuable guidelines for informing therapeutic decisions and striving to achieve the most favorable patient outcomes [1,7,10].…”

Section: Discussionmentioning

confidence: 99%

“…Among bone metastases, the spine is the most affected (33.9%), followed by the pelvis (30.5%), skull (27.1%), long bones (16.9%), and sternum (11.9%). Unfortunately, the prognosis for metastatic FTC is generally unfavorable, with a ten-year survival rate plummeting to 3-21% when bone metastasis is present [1,7,13].…”

Section: Introductionmentioning

confidence: 99%

Sternal Metastasis in Follicular Thyroid Carcinoma: An Atypical Presentation

HIND. OUAKRIM,

NADA. EL IDRISSI DAFALI,

SANA. RAFI

et al. 2023

World J. Adv. Res. Rev.

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Follicular Thyroid Carcinoma (FTC), the second most common type of thyroid cancer, accounts for 10-20% of thyroid cancers, primarily affecting individuals over 40, and it tends to spread hematogenously to various organs. It often metastasizes to the lungs (49%) and bones (7-28%), including the spine, pelvis, skull, long bones, and rarely, the sternum. Metastatic FTC carries a poor prognosis, with a 3-21% ten-year survival rate when bone metastases are present. Sternal metastasis from thyroid carcinoma is exceptionally rare and significantly impacts prognosis. In this article, we present an unusual case of a 65-year-old patient who presented with a year-long compressive goiter. Examination revealed a firm, painless nodular goiter and a sternal mass. Tests showed a low TSH, normal T4, and thyroid nodules. Following thyroidectomy, a 7cm vesicular thyroid carcinoma was diagnosed. Sternal metastasis was confirmed through biopsy. The patient underwent sternal mass excision, responded well, and was referred for radioactive iodine therapy. Treatment options for metastases in FTC include surgery, radioactive iodine therapy and radiation. Surgical removal of metastases is crucial in such cases, as it can enhance the effectiveness of subsequent treatments and improve patient outcomes. This comprehensive management approach can offer a better quality of life and extended survival for patients facing this uncommon but challenging situation.

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“…Они плохо отвечают на радиойодтерапию, и полная ремиссия костных метастазов составляет всего лишь 10-17 %. 8,9].…”

Section: Introductionunclassified

PET/CT with <sup>18</sup>F-FDG for TENIS Syndrome in a Patient with Bone Metastasis of Hurthle Cell Thyroid Cancer: a Clinical Case Report

Li,

Geliashvili,

Sushencov

et al. 2024

jour

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A significant role in improving the prognosis of differentiated thyroid cancer (DTC) in the presence of bone metastases is determined by early diagnosis of metastases, timely and correctly selected treatment tactics for the patient. During dynamic follow-up of patients with DTC after combined treatment (thyroidectomy with radioiodine therapy) are determination of the level of oncomarkers (serum thyroglobulin and antibodies to thyroglobulin) and ultrasound diagnostic of the neck, scanning with radioactive iodine (if clinically indicated). In some cases, patients have TENIS-syndrome (Thyroglobulin Elevated Negative Iodine Scintigraphy, hereinafter TENIS-syndrome), characterized by high serum thyroglobulin level in blood and absence of radioactive iodine accumulation on post therapeutic scintigraphy. According to the research studies, PET/CT with 18F-FDG has high sensitivity and specificity (89 % and 72 %, respectively) in visualization of metastatic radioiodine refractory foci in TENIS-syndrome.This article presents a clinical case of a patient, a 52-year-old woman with Gurtle cell thyroid cancer (pT3aN0M0, stage I) with established TENIS syndrome. Thyroidectomy was performed in September 2019 and radioiodine therapy was performed in January 2022 due to suspected disease progression given high thyroglobulin levels. Given the absence of pathologic accumulation of 131I according to post-therapy radioiodine scanning, PET/CT with 18F-FDG was performed, which revealed a solitary metastasis in the left iliac bone (41×35×42 mm with SUVmax 17.25). In November 2022, radical treatment of the solitary bone metastasis was performed in the scope of resection of the left iliac bone with reconstructive-plastic component. According to the data of control examinations in June 2023, the patient has a complete biochemical and radiologic remission of the disease.

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Synchronous Sternal Metastasectomy and Total Thyroidectomy for Differentiated Thyroid Cancer: A Rare Case Report

Cited by 4 publications

References 19 publications

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

Sternal Metastasis in Follicular Thyroid Carcinoma: An Atypical Presentation

PET/CT with <sup>18</sup>F-FDG for TENIS Syndrome in a Patient with Bone Metastasis of Hurthle Cell Thyroid Cancer: a Clinical Case Report

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