Thyroid Gland Hemorrhage in a Patient with Past Medical History of Renal Clear Cell Carcinoma: Report of a Very Rare Case

Abstract

Patient: Male, 68Final Diagnosis: Metastasis of renal clear cell carcinomaSymptoms: Chest pain irradiating in the left shoulder • tachycardia • increased dysphoniaMedication: —Clinical Procedure: Total thyroïdectomySpecialty: SurgeryObjective:Rare diseaseBackground:The incidence of metastasis to the thyroid gland is extremely rare, with hemorrhage being a particularly uncommon manifestation of metastatic thyroid disease.Case Report:A 68-year-old man who underwent a right nephrectomy for RCC 8 years ago was referred to the Emergency Department (ED) complaining of upper-chest pain radiating to the left shoulder, tachycardia, and increased dysphonia. An enhanced computed tomography (CT) scan suggested a thyroid mass originating from both thyroid lobes, with right deviation of the trachea due to active bleeding. The patient underwent an emergency total thyroidectomy. The postoperative course was uneventful. The histopathological analysis of the surgical specimen revealed metastasis of an RCC.Conclusions:Active bleeding of the thyroid gland is a formal indication for emergency surgical management. In patients with a history of cancer, especially in cases of RCC, metastatic disease should be suspected, although in most cases the final diagnosis can only be made after surgery.

Metastatic renal cell carcinoma to the pancreas, thyroid, & subcutaneous tissue 13 years after Radical nephrectomy: A case report

“…Although it is still not well understood how metastasis targets the thyroid gland, the suggested theory is that it occurs because the thyroid gland is rich with blood supply. Moreover, abnormal thyroid gland has been reported in the literature to be more susceptible to metastasis, which was evident in our patient as the histopathology showed evidence of subclinical thyroiditis [2,5].…”

“…Only a few reported cases presented with metastatic lesions, which were most commonly found in intra-abdominal organs, brain, bones, and lungs [2,4]. RCC can metastasize even after decades of complete excision of the primary tumor, with around 30% of patients presenting with a recurrence years later [5]. It can also metastasize to unusual sites, such as the pancreas.…”

Title clear cell renal carcinoma metastasis mimicking primary thyroid tumor

“…The prevalence of solitary CCRC metastases is approximately 4%. 3 The most common metastatic sites are the lungs, adrenal glands, gastrointestinal tract, brain, lymph nodes, bone, (mean, 4.1 years); 1 individual died due to disease other then CCRC metastases; and 3 patients are still alive without symptoms of CCRC. The median survival was estimated at 2.5 years with a 5 -year survival rate of approximately 11%.…”

“…1,3 Nevertheless, the thyroid gland is considered an atypical localization of CCRC metastases, along the orbits, parathyroid glands, nasal and paranasal cavities, tongue, tonsils, heart, skin, muscles, and joints. 3,9 The majority of patients present a metastatic thyroid tumor many years after an initial CCRC diagnosis and effective treatment. There have been several reports of late metastasis from CCRC, which may occur even many years after nephrectomy.…”

“…An extremely rare manifestation of thyroid CCRC metastasis might be the active bleeding of the thyroid gland. 3 Regardless of the high sensitivity and specificity of some diagnostic modalities to detect thyroid nodules, many of them are still insufficient for the diagnosis of thyroid metastatic tumors. The situation might be even more challenging when the thyroid nodule is the initial manifestation of renal disease.…”