Thyroid follicular carcinoma presenting as metastatic skin nodules

Abstract

BackgroundFollicular thyroid cancer (FTC) metastasizes most commonly to the lungs and non-cranial bones. Skull and skin are uncommon sites and usually manifest well after the diagnosis of primary malignancy. Metastasis to skull and skin as the presenting feature of FTC is infrequently reported in the literature.Case presentationA 65-year-old Caucasian woman with a history of thyroid nodule presented with the complaint of rapidly growing skull nodules which had been present for 3 years but were stable previously. She denied any fevers, chills, history of trauma, or weight loss. She denied any history of smoking or head and neck irradiation. On physical examination, she had two non-tender gray cystic lesions – one on her left temporal region and the other on the right parietal region. Biopsy was consistent with metastatic FTC. Magnetic resonance imaging of the brain demonstrated 7.1×3.8 cm and 3.7×4.5 cm fairly homogeneous, enhancing, relatively well-defined masses centered in the posterior and left anterior lateral calvarium with intracranial and extracranial extensions but without any vasogenic edema or mass effect on the brain. Thyroid ultrasound showed numerous nodules in both lobes. The patient underwent a total thyroidectomy. Histopathological studies of the thyroid gland revealed a well-differentiated FTC in the left lobe. Then she underwent resection of the tumor in multiple stages. She did not have any recurrence of the FTC or metastases during the follow-up period and will be receiving radioactive iodine treatment.ConclusionBone and lung are the common sites of metastasis from FTC, but involvement of skull or skin is unusual, particularly as the presenting feature. Metastases from FTC should be in the differential of patients with new osteolytic hypervascular skull lesions or cutaneous lesions in head and neck area.

An H-TERT Mutated Skin Metastasis as First Occurrence in a Case of Follicular Thyroid Carcinoma

“…In fact, Somoza et al reported a similar case, that of a 71-year-old Caucasian male with a skin metastasis of about 1 cm from a follicular variant of PTC (17), and Smit et al found a 79-year-old Caucasian woman with skin metastases as the first manifestation of a follicular variant of PTC (18). Jehangir et al also observed a Caucasian woman with a history of thyroid nodule who had rapidly growing skull nodules and a histological diagnosis of FTC (19), and Shamim et al published two case reports in which a skull lesion was the first manifestation (20). In all these cases, however, the skin lesions were far more advanced than in our case.…”

Scalp, Skull, Lung and Bone Metastasis from Follicular Thyroid Carcinoma - A Rare Case Report

“…Sorafenib was planned for palliative intent. Asad Jehangir et al reported a 65-year-old Caucasian woman with a history of thyroid nodule presented with the complaint of rapidly growing skull nodules which had been present for 3 years but were stable [20]. The prognosis is relatively poor in metastatic follicular thyroid carcinoma with 5 and 10 years mortality rates of approximately 60% and 80% respectively [10].…”

Skin metastasis as incidental finding in follicular epithelium derived – thyroid cancer

“…If tumour removal is less indicated in mentioned pituitary and adrenal incidentalomas, surgery for an incidental thyroid nodule is recommended depending on complex risk stratification strategy of approach (1,22,27). Incidental finding of a skin lump originating from a thyroid cancer remains an exceptional scenario (28,29,30). Whole body imagery evaluation may show the general metastatic context if positive or it may suggest the thyroid origin especially in patients with prior thyroidectomy and a certain disease free interval (28,29,30).…”

“…Incidental finding of a skin lump originating from a thyroid cancer remains an exceptional scenario (28,29,30). Whole body imagery evaluation may show the general metastatic context if positive or it may suggest the thyroid origin especially in patients with prior thyroidectomy and a certain disease free interval (28,29,30). Overall, histological report, radioiodine uptake at scintigraphy or high circulating thyroglobulin of otherwise unexplained source are the best assessments for an adequate diagnosis and further therapy even the general prognosis is considered severe in this cases (28,29,30).…”