|
1
|
Tanaka A, Hirokawa M, Suzuki A, Higuchi M, Miyauchi A, Akamizu T. Clinical, cytological, and pathological characteristics of metastatic renal cell carcinoma to the thyroid: A study of 14 cases at a Japanese single institution. Pathol Int 2023; 73:351-357. [PMID: 37314120 PMCID: PMC11551830 DOI: 10.1111/pin.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
A preoperative diagnosis of metastatic renal cell carcinoma to the thyroid (MRCCT) is important for determining clinical management but is challenging even in cases with a clinical history of renal cell carcinoma (RCC). This study aimed to elucidate the clinical, cytological, and pathological characteristics of MRCCT. Fourteen MRCCT cases extracted from 18 320 malignant thyroid tumors were included in this study. Twelve MRCCT (85.7%) occurred as solitary lesions and the most frequently suspected lesions on ultrasonography were follicular tumors. On cytology, 46.2% of cases were reported as RCC or suspected RCC; a medical history of RCC and immunocytochemistry were helpful in interpretation. RCC metastasized to a follicular adenoma in 50.0% of the solitary lesions. MRCCTs with a long interval from the initial presentation, solitary lesion, and Ki-67 labeling index <10% showed significantly longer disease-free survival. MRCCT is characterized by a long interval from the initial presentation of RCC, appearance as a solitary nodule, ultrasonographic similarity to follicular tumors, sharing cytological findings with primary thyroid tumors, and high frequency of metastasis within follicular adenoma. A long interval from the initial presentation, occurrence as a solitary lesion, and low Ki-67 labeling index may be favorable prognostic factors.
Collapse
Affiliation(s)
- Aki Tanaka
- Department of Diagnostic Pathology and CytologyKuma HospitalKobeJapan
| | | | - Ayana Suzuki
- Department of Diagnostic Pathology and CytologyKuma HospitalKobeJapan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and CytologyKuma HospitalKobeJapan
| | | | | |
Collapse
|
|
2
|
Xie R, Tan D, Liu B, Han X, Jin X, Shen D, Zhou L, Shen J. Kidney cancer with thyroid metastasis combined with thyroid carcinoma, a case report. BMC Endocr Disord 2023; 23:95. [PMID: 37106342 PMCID: PMC10134650 DOI: 10.1186/s12902-023-01332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Thyroid cancer is the most common malignant tumor of the endocrine system. There have been some reports on kidney cancer with thyroid metastasis. However, kidney cancer has rarely been detected during thyroid cancer surgery. CASE PRESENTATION We present a rare case of kidney cancer with thyroid metastasis, combined with thyroid carcinoma. A 66-year-old woman was admitted to our hospital in September 2021 due to enlarged left thyroid nodules for two years. The patient was diagnosed with a left thyroid nodule on physical examination in 2012. Extended radical resection of the thyroid cancer was performed. Intraoperatively, two thyroid lesions were identified. Thus, the patient was definitively diagnosed with kidney cancer with thyroid metastasis and papillary thyroid carcinoma. Furthermore, two metastatic nodules due to kidney cancer and one metastatic lymph node lesion due to thyroid cancer were found in the loose connective tissue adjacent to the thyroid. CONCLUSIONS Kidney cancer with thyroid metastasis and thyroid carcinoma rarely co-occur, and it is difficult to identify the primary tumor. Although clinical examination methods are increasingly updated, the past medical history and physical examination are still very important.
Collapse
Affiliation(s)
- Rongli Xie
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dan Tan
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Boke Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xujie Han
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoli Jin
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dongjie Shen
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Zhou
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jiankang Shen
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
|
3
|
Wu Y, Huang K, Zheng X, Gao M, Liu H. Tumor Biology is King: Secondary Tumors of the Thyroid From 2 Medical Centers in China. Cancer Control 2021; 27:1073274820945984. [PMID: 32779493 PMCID: PMC7791472 DOI: 10.1177/1073274820945984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We studied the clinical characteristics, diagnosis, treatment, and prognosis of secondary tumors of the thyroid (STTs) and analyzed this rare phenomenon based on our clinical experience. METHODS We reviewed 16 000 malignant thyroid tumors diagnosed at 2 medical centers in China from 1978 to 2018, including 55 patients with STTs. RESULTS The most frequent primary tumor sites included lung (21.8%), gastrointestinal (18.2%), breast (14.5%), and kidney (12.7%). The median age at STT diagnosis was 56 years. The time from diagnosis of primary tumor to metastases to the thyroid ranged from 0 to 108 months, with the longest interval being for renal cell carcinoma (RCC; mean: 49 months). There were 22 cases of single metastatic foci and 33 cases of multiple metastatic foci. At the time of STT diagnosis, 42 patients had multiple organ metastases and 13 patients had only thyroid metastases. Thyroid function was examined in 50 patients, including 23 with Hashimoto's thyroiditis. Metastases were diagnosed histologically and confirmed by negative immunohistochemistry for thyroid markers. Twenty-one patients were treated with resection, including total thyroidectomy in 14 and unilateral lobectomy in 7. Thirty-four patients were treated without resection, but 2 were treated with tracheotomy. The median survival time of all patients with metastasis was 10 months (range: 1-96 months). Patients with primary RCC had the best prognosis (median survival time: 52 months), followed by patients with breast cancer (33 months). Patients who underwent thyroid surgery had a better prognosis than patients without thyroid surgery. Patients with single metastatic foci or single organ metastases had a better prognosis than patients with multiple metastatic foci or multiple organ metastases. CONCLUSIONS Metastasis to the thyroid is a rare clinical phenomenon, and sometimes a diagnosis of STT is difficult; so, we need to pay more attention to it. While prognosis appears to be related to surgery or some characteristics of metastatic spread, these data suggest it is more complex. Tumor biology is king; in fact, prognosis was mainly related to the biological behavior of the primary tumor. We cannot only opt for surgery; thus, case selection is important, and the treatment strategy for STT patients should be determined individually according to their specific biological behaviors.
Collapse
Affiliation(s)
- Yu Wu
- Department of Head and Neck Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Kai Huang
- Department of Breast Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Hui Liu
- Department of Head and Neck Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| |
Collapse
|
|
4
|
Tjahjono R, Phung D, Gurney H, Gupta R, Riffat F, Palme CE. Thyroid gland metastasis from renal cell carcinoma: a case series and literature review. ANZ J Surg 2020; 91:708-715. [PMID: 33319504 DOI: 10.1111/ans.16482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the most common malignancy that metastasises to the thyroid. This study aims to better understand the clinical characteristics of patients with thyroid metastasis from RCC. METHODS A retrospective case series of patients with thyroid metastasis from RCC between 2008 and 2020 from two tertiary centres were examined. MEDLINE and PubMed database searches were performed to retrieve the relevant literature. RESULTS Fifteen patients (eight males) were identified, with a median age of 57.0 (interquartile range (IQR) 51.0-63.0) at time of RCC diagnosis. Median time to thyroid metastasis was 92.0 months (IQR 40.0-156.0), with 12 (80.0%) patients undergoing thyroidectomy within 2 months of diagnosis. No patients developed post-operative complications or local thyroid recurrence. The two most common non-thyroid metastatic sites in this case series are lungs and bone (five patients, respectively; 33.3%) and pancreas (four patients; 26.7%). Ten (66.6%) patients underwent systemic chemotherapy, and five (33.4%) patients underwent radiotherapy for other sites of metastasis. Median survival following thyroid metastasis was 54.0 months (IQR 15.0-100.0). The literature review was conducted through MEDLINE and PubMed database searches, and 30 papers were considered relevant to this review. Results from our study are comparable to those reported in the literature. CONCLUSION Thyroid metastases can occur long after nephrectomy and portends a better prognosis. To prevent development of central neck disease, thyroidectomy should be considered.
Collapse
Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Howard Gurney
- The Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Faculty of Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,The Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| |
Collapse
|
|
5
|
Rodrigo-Gómez L, Pardal-Refoyo JL, Batuecas-Caletrío Á. Prevalencia de tumores metastásicos en la glándula tiroides. Revisión sistemática y metanálisis. REVISTA ORL 2020. [DOI: 10.14201/orl.23207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: Los tumores metastásicos en la glándula tiroides complican el diagnóstico, el tratamiento y el pronóstico del paciente. El objetivo es conocer la prevalencia de las metástasis en la glándula tiroides referida en la literatura médica y los tumores primarios que con más frecuencia metastatizan en la glándula tiroides. Método: Se realizó una revisión bibliográfica sistemática en las bases de datos de PubMed, La Biblioteca Cochrane y Scopus. Los artículos seleccionados se dividieron en dos grupos, series clínicas de pacientes en los que se hallaron metástasis en tiroides (grupo A) y series de hallazgos de metástasis en tiroides en autopsias (grupo B). Se realizó metanálisis de prevalencia para cada grupo de artículos siguiendo el modelo de efectos aleatorios. Resultados: La prevalencia en cada grupo con su índice de confianza al 95% fue 0.00479 (0.002-0.007) para el grupo A y 0.0362 (0.014-0.059) para el grupo B. La prevalencia de metástasis halladas en autopsias fue 7,58 veces mayor que en los estudios clínicos. En el grupo A la edad media fue 60.82 y en el grupo B 57.20. En ambos grupos las metástasis halladas en tiroides fueron más frecuentes en el sexo femenino. La localización del tumor primario fue diferente en ambos grupos, en el grupo A fue el cáncer de riñón y en el grupo B el cáncer de mama. La variabilidad de la prevalencia de metástasis en tiroides en los diferentes artículos de ambos grupos hace que este estudio tuviese una alta heterogeneidad (índice I2 y Q). Los funnel plot de ambos grupos indicaron alto sesgo de publicación. Discusión: La diferente prevalencia entre series clínicas y autopsias puede implicar que la detección de metástasis en tiroides en la clínica está infradiagnosticada. La razón de esto podría ser que las metástasis intratiroideas se presentan de forma asintomática siendo diagnosticadas como hallazgo casual en autopsias. En otras ocasiones se presentan como un nódulo tiroideo años después del tumor primario, lo que condiciona el diagnóstico. Conclusiones: La prevalencia de metástasis en tiroides es superior en las series de autopsias que en series clínicas (hasta 6.67 veces más frecuente en nuestro estudio). Las metástasis intratiroideas probablemente están infradiagnosticadas por cursar sin clínica siendo diagnosticadas como hallazgo casual en autopsias. Los tumores primarios más frecuentes fueron el riñón (series clínicas) y la mama (series de autopsias).
Collapse
|
|
6
|
Dr Hall B, Abel EJ. The Evolving Role of Metastasectomy for Patients with Metastatic Renal Cell Carcinoma. Urol Clin North Am 2020; 47:379-388. [PMID: 32600539 DOI: 10.1016/j.ucl.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Surgical metastasectomy continues to be utilized for patients with solitary or low-volume metastatic renal cell carcinoma (mRCC). Although few high-quality data are available to evaluate outcomes, local treatment is recommended when feasible because it may allow a subset of patients to delay or avoid systemic treatments. With the development of improved mRCC therapies, utilization of metastasectomy has increased because most patients have incomplete responses to systemic treatment of their metastases. This review discusses the rationale and history of metastasectomy, trends in utilization, prognostic factors for patient selection, site-specific considerations, alternatives for nonsurgical local treatment, and risk of morbidity associated with metastasectomy.
Collapse
Affiliation(s)
- Bryan Dr Hall
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA.
| |
Collapse
|
|
7
|
Khaddour K, Marenych N, Ward WL, Liu J, Pappa T. Characteristics of clear cell renal cell carcinoma metastases to the thyroid gland: A systematic review. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
|
8
|
Khaddour K, Marernych N, Ward WL, Liu J, Pappa T. Characteristics of clear cell renal cell carcinoma metastases to the thyroid gland: A systematic review. World J Clin Cases 2019; 7:3474-3485. [PMID: 31750330 PMCID: PMC6854394 DOI: 10.12998/wjcc.v7.i21.3474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroid gland is an uncommon site for metastases from clear cell renal cell carcinoma (CCRCC) and literature is scarce. Due to the variable and often long lag time before development of metastases in patients with CCRCC, thyroid nodules may be misdiagnosed initially as benign. This systematic review aims at a better understanding of the nature of these metastases.
METHODS A bibliographic search was performed using PubMed (1990-2019), key words being “renal cell carcinoma, thyroid, kidney cancer, clear cell.” 147 cases were analyzed. The patient’s characteristics assessed were: age, sex, stage, size of metastases, lag time, diagnostic modality, initial symptoms, treatment and outcome in last documented follow up. Binary logistic regression, Spearman’s rho and ANOVA were used to identify differences between the existing variables.
RESULTS The mean age (± SD) was 64 ± (10) years in males and 64 (± 11) in females. The mean lag time to diagnosis of thyroid metastases was 8.7 (± 6.3) years. Gender distribution of the patients was 46.3% male, 52.4% female. There was a weak correlation between lag time and size of metastases, not statistically significant. Size of metastases was significantly higher in symptomatic patients (6.06 ± 3.51 cm) compared to those with painless mass (4.6 ± 0.29 cm) and asymptomatic ones (3.93 ± 1.99 cm) (P = 0.03). Fine Needle Aspiration was diagnostic in 29.4% of cases, 47.1% were non diagnostic. Most patients (80.3%) underwent thyroid surgery. At 1 year follow up, 55.6% of patients operated were alive versus 35.3% who did not have surgery, though this was not statistically significant (P = 0.1).
CONCLUSION A larger size of thyroid metastasis was more likely to present with symptomatology. A high index of suspicion is warranted when evaluating thyroid nodules in CCRCC patients. There was no significant difference in outcome between patients who underwent surgery and those who did not. With the wider use of immune check-point inhibitors and tyrosine kinase inhibitors in metastatic CCRCC, surgery may eventually be reserved only for palliative purposes.
Collapse
Affiliation(s)
- Karam Khaddour
- Department of Medicine at Rosalind Franklin University of Medicine and Science, Chicago, IL 60050, United States
| | - Nadiia Marernych
- Department of Medicine at Rosalind Franklin University of Medicine and Science, Chicago, IL 60050, United States
| | - Wendy L Ward
- Northwestern Medicine McHenry, Chicago, IL 60050, United States
| | - Jerry Liu
- Advocate Medical Group Oncology, Crystal Lake, IL 60014, United States
| | - Theodora Pappa
- Department of Medicine at Rosalind Franklin University of Medicine and Science, Chicago, IL 60050, United States
| |
Collapse
|
|
9
|
Geisbush TR, Dymon Z, Gabriel MS, Yedavalli V. A Multimodal and Pathological Analysis of a Renal Cell Carcinoma Metastasis to the Thyroid Gland 11 Years Post Nephrectomy. J Radiol Case Rep 2019; 13:1-9. [PMID: 31565176 PMCID: PMC6743643 DOI: 10.3941/jrcr.v13i4.3497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Thyroid lesions have a comprehensive differential diagnosis which include benign and malignant entities, such as metastases. However, metastases only account for a small percentage of thyroid lesions with renal cell carcinoma as the most common. Metastases to the thyroid pose a diagnostic dilemma as symptoms may not manifest for up to decades after removal of the renal cell carcinoma. Due to the nonspecific appearance on computed tomography and ultrasound, distinguishing metastases from primary thyroid malignancies is of the utmost importance for timely patient management. Our case demonstrates the importance of considering RCC metastases to the thyroid even years after nephrectomy to mitigate potential delays in diagnosis. We present the case of a 66-year-old male with a past medical history of renal cell carcinoma status post nephrectomy 11 years prior who demonstrated incidental thyroid abnormalities on positron emission tomography/computed tomography and ultrasound later confirmed as a metastasis of renal cell carcinoma.
Collapse
Affiliation(s)
- Thomas Rand Geisbush
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Zaneta Dymon
- Department of Radiology, Loyola University Medical Center, Illinois, USA
| | - Medhat Sam Gabriel
- Department of Radiology, Loyola University Medical Center, Illinois, USA
| | - Vivek Yedavalli
- Department of Neuroimaging and Neurointervention, Stanford Hospital, Palo Alto, USA
| |
Collapse
|
|
10
|
Pastorello RG, Saieg MA. Metastases to the Thyroid: Potential Cytologic Mimics of Primary Thyroid Neoplasms. Arch Pathol Lab Med 2018; 143:394-399. [PMID: 30444438 DOI: 10.5858/arpa.2017-0570-rs] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Secondary tumors of the thyroid gland, although uncommon, can sometimes pose as diagnostic dilemmas on fine-needle aspiration cytology, frequently mimicking primary thyroid neoplasms. An accurate diagnosis of such lesions, however, is critical for patient management and prognosis. The present study reviews the cytologic aspects of secondary involvement of the thyroid, listing the most common primary malignancies that metastasize to this gland. Knowledge of such morphologic aspects, combined with prompt clinical correlation, is essential for the cytopathologist to achieve a proper, definite diagnosis.
Collapse
Affiliation(s)
- Ricardo Garcia Pastorello
- From the Department of Pathology, A.C. Camargo Cancer Center, Sao Paulo, Brazil (Drs Pastorello and Saieg); and the Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil (Dr Saieg)
| | - Mauro Ajaj Saieg
- From the Department of Pathology, A.C. Camargo Cancer Center, Sao Paulo, Brazil (Drs Pastorello and Saieg); and the Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil (Dr Saieg)
| |
Collapse
|
|
11
|
Metastatic clear cell renal cell carcinoma to the thyroid gland: A clinico-pathological and immunohistochemical study of 8 cases and review of the literature. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 52:81-86. [PMID: 30902382 DOI: 10.1016/j.patol.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/14/2018] [Accepted: 08/24/2018] [Indexed: 01/25/2023]
Abstract
When a patient with a previous history of neoplasm presents with a thyroid lesion, the possibility of it being metastatic should always be considered. In this series, we present the clinicopathological and immunohistochemical features of the thyroid metastases diagnosed in our department over the past 30 years. Here we present eight thyroidal metastases from clear cell renal cell carcinoma (ccRCCC), including a tumor to tumor metastasis, the patients being 2 men and 6 women with a median age of 62 years. The majority had a past history of goiter and a single and palpable metastasis. In one patient the thyroid metastases were the first sign of the ccRCCC. In the available cases, the metastasis showed positivity to PAX8 and CAIX and negativity to TTF1 and thyroglobulin. The median time from the detection of the primary renal tumor to thyroid metastasis and from thyroidectomy to last follow up were 84.17 and 54.50 months, respectively. After a median follow up of 158.50 months none of the patients had died from ccRCCC. Renal cell carcinoma (RCC) is the most frequent malignant neoplasm of the kidney and its incidence has increased over recent decades. In a clinical series, up to 1-3% of the oncologic thyroidectomies were due to thyroid metastases and the most frequent metastasizing tumor was RCC, followed by lung and breast cancer.
Collapse
|
|
12
|
Connolly CE. Renal cell metastasis to the thyroid gland: An emerging phenomenon. Int J Surg Case Rep 2018; 45:104-106. [PMID: 29604529 PMCID: PMC6000999 DOI: 10.1016/j.ijscr.2018.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
Intra-thyroid metastases are rare and account for 1–3% of all thyroid malignancies. Renal cell carcinoma has overtaken melanoma and breast carcinoma to become the commonest primary source of intra-thyroid metastases. Renal cell carcinoma metastasising to the thyroid gland has a mean spread interval of 9 years. The pathophysiology and treatment of renal cell thyroid metastases requires further research. Introduction Suspected thyroid malignancies are usually assumed to be primary in origin. Rarely, in 1–3% of cases, the tumour arises from a secondary source such as a melanoma or breast carcinoma. There is a growing body of research concerning metastatic spread of renal cell carcinoma to the thyroid gland. Presentation of case This case report describes the presentation and diagnostic work-up of an 84yr male presenting with a goitre and hoarse voice. Histopathological examination of the excised 95 × 65 × 55 mm tissue mass revealed metastatic clear cell renal cell carcinoma. Discussion This disease pattern has become increasingly apparent in recent literature. A literature review of 150 documented cases worldwide showed that the mean interval for this spread to occur is 9 years. Conclusion There is a need for further investigation into the underlying pathophysiology of this phenomenon and increased awareness from clinicians of its existence.
Collapse
|
|
13
|
Cesaretti M, Trotta M, Varaldo E, Ansaldo G, Leale I, Borgonovo G. Metastases to the thyroid gland from renal cancer. TUMORI JOURNAL 2018; 99:e107-10. [DOI: 10.1177/030089161309900327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aims and background Metastases to the thyroid gland from renal cancer pose a challenge to physicians, due in part to the rarity of the phenomenon, the prolonged time interval between removal of the primary renal cancer and the appearance of metastases, the difficulty in diagnosis, and the uncertainty regarding long-term prognosis. We report our experience with diagnosis and management of patients affected by thyroid metastases from renal clear cell carcinoma. Study design We report herein three clinical cases of thyroid metastases from renal clear cell carcinoma. We also present a review of the literature and examine common features of clinical presentation and management recommendations. Results Over the past 17 years, 918 patients underewent surgery for thyroid cancer in our institution. Histological examination demonstrated a thyroid secondary malignancy from kidney cancer in 3 cases. Two patients underwent total thyroidectomy, whereas in the third patient a palliative right lobectomy with homolateral latero-cervical lymphoadenectomy was performed. At a 5-year follow-up, only one patient survived and was disease-free. Conclusions Thyroid metastases from renal clear cell carcinoma are a rare occurrence but should be taken into consideration in the differential diagnosis of a thyroid nodule. Preoperative diagnosis is often difficult. Nevertheless, an extensive diagnostic workup is recommended because the subsequent therapy must be tailored on the basis of the local extension of metastases. Surgical treatment of solitary thyroid metastases is recommended. However, patients with disseminated disease have a poor prognosis, and palliative care is the indicated recommendation. In these patients and in surgically untreatable patients, prolonged survival may be achieved by adjuvant medical therapy.
Collapse
Affiliation(s)
- Manuela Cesaretti
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Manuela Trotta
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Emanuela Varaldo
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Gianluca Ansaldo
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Irene Leale
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| | - Giacomo Borgonovo
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), IRCCS AOU San Martino — IST, Genoa, Italy
| |
Collapse
|
|
14
|
Straccia P, Mosseri C, Brunelli C, Rossi ED, Lombardi CP, Pontecorvi A, Fadda G. Diagnosis and Treatment of Metastases to the Thyroid Gland: a Meta-Analysis. Endocr Pathol 2017; 28:112-120. [PMID: 28332062 DOI: 10.1007/s12022-017-9475-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The thyroid is a rare site of clinically detectable tumor metastases; even though the gland is a highly vascularized structure, the frequency of metastases in the routine practice is less than 0.2% of all thyroid malignancies. The purpose of our meta-analysis is to evaluate the frequency of metastatic diffusion from other primary tumors to the thyroid gland and to suggest the best possible treatment through an evidence-based study. Relevant studies were identified by searching the following databases: PubMed, Scopus, and Web of Science. We selected all English-written articles published from 1995 to 2015. Studies were considered eligible if they reported the timing of metastatic spread and the site of the primary tumor in respect to the diaphragmatic region. Case reports were not included. Twenty-eight studies accounted for 514 patients. The rate of metachronous metastases was 69%. Fifty-three percent of primaries originated from the infradiaphragmatic region. Fine needle aspiration biopsy (FNAB) was done in 154 patients and 195 patients were treated mostly with surgery. A prevalence of primary tumors from the infradiaphragmatic region and of metachronous metastases was observed. Knowledge of the clinical history and the ancillary techniques can improve the sensitivity and accuracy of FNAB. Thyroidectomy may be considered a more effective treatment than radio-chemotherapy.
Collapse
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Claudia Mosseri
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Chiara Brunelli
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Largo Francesco Vito 1, 00168, Rome, Italy.
| |
Collapse
|
|
15
|
Thiam I, Doh K, Hassan-Farah S, Tagba E, Leloua A, Woto-Gaye G. [Intra-thyroid metastasis and the pathologist]. Ann Pathol 2017; 37:170-174. [PMID: 28291559 DOI: 10.1016/j.annpat.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/06/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
Intra-thyroid metastases (ITM) are rarely observed clinically. The high blood flow of the thyroid and its high content of iodine explain this rarity. The clinical and radiological criteria of ITM are not very specific. The pathologist is the principal actor of ITM diagnosis. Cytology, intraoperative examination and histological techniques are the means available. The microscopic aspects of ITM are varied. Art is to differentiate ITM to undifferentiated primary tumor. We report two cases of ITM in patients aged 49 and 52 years, respectively. We discuss diagnostic methods and challenges for pathologists in identifying such lesions.
Collapse
Affiliation(s)
- Ibou Thiam
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal.
| | - Kwame Doh
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal.
| | - Samatar Hassan-Farah
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal.
| | - Essolam Tagba
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital régional de Ziguinchor, Ziguinchor, Sénégal
| | - Adolph Leloua
- Service d'urologie-andrologie, hôpital Général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - Gisèle Woto-Gaye
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Aristide Le Dantec, BP : 3001 Anta Diop, Dakar, Sénégal
| |
Collapse
|
|
16
|
Surov A, Machens A, Holzhausen HJ, Spielmann RP, Dralle H. Radiological features of metastases to the thyroid. Acta Radiol 2016; 57:444-50. [PMID: 25907117 DOI: 10.1177/0284185115581636] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/20/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thyroid metastases (TM) are uncommon. Dependent on study design, the reported frequency of TM is in the range of 0.1-6% in different analyses. While clinical and histopathological features of TM were well described in the literature, radiological publications consist predominantly of isolated case reports or small series. PURPOSE To estimate the prevalence, clinical signs, and radiological appearances of TM. MATERIAL AND METHODS From 1997 to 2013, a total of 8849 patients with various disorders of the thyroid gland were treated in our institution. In 33 patients TM were diagnosed. Ultrasound (US) images were available in all patients, computed tomography (CT) of the neck in 16 patients, and magnetic resonance imaging (MRI) in nine patients. RESULTS Clinically, most patients (85%) presented with a painless neck mass. Primary tumors were renal cell carcinoma (79%), colorectal cancer (12%), lung cancer (3%), rhabdomyosarcoma (3%), and breast carcinoma (3%). On US, most lesions were irregular in shape with inhomogenous texture. On CT, all TM were hypodense. On T1-weighted images, most TM were inhomogenously iso-to-hyperintense in comparison to the normal thyroid tissue, and slightly hyperintense on T2-weighted images with an inhomogenous contrast enhancement. CONCLUSION The prevalence of TM was 0.4%. Most of the TM originated from renal cell carcinoma. The identified radiological features of TM should be taken into consideration in the differential diagnosis of thyroid lesions.
Collapse
Affiliation(s)
- Alexey Surov
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Machens
- Department of Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Rolf Peter Spielmann
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Henning Dralle
- Department of Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
|
17
|
Gheorghiu ML, Iorgulescu R, Vrabie CD, Tupea CC, Ursu HI. THYROID METASTASIS FROM CLEAR CELL CARCINOMA OF THE KIDNEY 16 YEARS AFTER NEPHRECTOMY. ACTA ENDOCRINOLOGICA-BUCHAREST 2016; 12:80-84. [PMID: 31258806 DOI: 10.4183/aeb.2016.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The thyroid gland is one of the most vascularized organs in the body. However, metastatic disease to the thyroid gland is rare. When it does occur kidney is the most common primary tumor site, followed by melanoma, lung, breast, esophagus, uterus and colon carcinoma. We describe the case of an isolated thyroid metastasis from clear cell renal carcinoma occurring 16 years after nephrectomy. An 82 years-old woman presented for the recent growth of a right thyroid nodule, diagnosed 3 years before, when a fine needle aspiration biopsy found a benign cytology suggesting a well-differentiated follicular thyroid adenoma. Her medical history included type 2 diabetes mellitus, atrial fibrillation and a right nephrectomy for a clear cell renal carcinoma done 16 years before. The patient has lost weight but she was otherwise asymptomatic. The right lobe goiter was painless, firm, and mobile with deglutition, without signs of local compression or latero-cervical lymphadenopathy. Thyroid ultrasonography revealed an enlarged (9.9 cm) macronodular right lobe, with multiple cystic areas, with normal left lobe and a thrombus in the right internal jugular vein. Thyroid function tests were normal. The patient was suspected of thyroid carcinoma and underwent a near total thyroidectomy. Histopathological examination revealed a metastasis of clear cell renal carcinoma in the right thyroid gland lobe (8.5/5/5 cm). Further imaging showed no primary tumor or other metastases. Metastatic renal carcinoma to the thyroid should be considered in any patient presenting with a thyroid mass and a medical history of operated renal cell carcinoma, since it can occur up to 25 years after nephrectomy.
Collapse
Affiliation(s)
- M L Gheorghiu
- "C. I. Parhon" Institute of Endocrinology, Dept of Neuroendocrinology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"C. I. Parhon" Institute of Endocrinology, Dept. of Endocrinology, Bucharest, Romania
| | - R Iorgulescu
- "C. I. Parhon" Institute of Endocrinology, Dept. of General Surgery, Bucharest, Romania
| | - C D Vrabie
- "C. I. Parhon" Institute of Endocrinology, Dept. of Pathology, "Sf. Ioan" Emergency Clinical Hospital, Bucharest, Romania.,"C. I. Parhon" Institute of Endocrinology, Dept. of Pathology, Bucharest, Romania
| | - C C Tupea
- "C. I. Parhon" Institute of Endocrinology, Dept. of Endocrinology, Bucharest, Romania
| | - H I Ursu
- "C. I. Parhon" Institute of Endocrinology, Dept. of Thyroid Disease, Bucharest, Romania.,"C. I. Parhon" Institute of Endocrinology, Dept. of Endocrinology, Bucharest, Romania
| |
Collapse
|
|
18
|
Abstract
OBJECTIVES Metastases to the thyroid gland are not as unusual as previously believed. This study reports the largest number of patients with metastatic disease of the thyroid to date, confirms the accuracy of fine-needle aspiration (FNA) in diagnosing metastasis, and reviews the incidence and management through our institutional experience. METHODS This study entailed review of all thyroid FNAs performed at Mayo Clinic, Rochester during the period 1980 to 2010 and identified 97 patients with a metastatic solid neoplasm of the thyroid gland. RESULTS Frequent primary tumor sites included kidney (22%), lung (22%), and head and neck (12%). The median age at discovery of thyroid metastasis was 63 years. The time from diagnosis of primary tumor to metastasis to the thyroid gland was most considerable for renal cell carcinoma (mean 113 mo). Forty-one patients underwent thyroid resection with an average tumor size of 3 cm. Median survival in all patients with metastases was 20 months (range, 1 to 228 mo). Patients who underwent thyroid resection had a median survival of 30 months (range, 3 to 171 mo), whereas survival in patients without thyroid surgery was 12 months (range, 1 to 228 mo, log-rank test P=0.09). CONCLUSIONS Our experience over the last 30 years confirms that FNA remains a sensitive and specific method to detect metastases to the thyroid. In any patient with a history of a malignancy, a new thyroid mass should be promptly evaluated for recurrent malignancy as early diagnosis and surgical resection resulted in a nonstatistically significant increased median survival.
Collapse
|
|
19
|
Thyroid metastasis from renal cell carcinoma-A case report after 9 years. Int J Surg Case Rep 2015; 16:59-63. [PMID: 26421840 PMCID: PMC4643339 DOI: 10.1016/j.ijscr.2015.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 01/31/2023] Open
Abstract
The thyroid gland is a rare site of clinically detectable tumor metastasis. Preoperative distinction between primary and secondary thyroid tumors is difficult. RCC disseminates in an unpredictable manner and can show late recurrences. Metastasis should be considered if history for RCC and a thyroid nodule is present. Introduction The thyroid gland is a rare site of clinically detectable tumor metastasis. As thyroid tumors are usually assumed to be primary in origin, its recognition as a secondary is difficult. Presentation of case We report a case of an 80-year old female who was referred to the Department of Surgery for a symptomatic thyroid nodule. Her medical history included a radical nephrectomy for renal cell carcinoma (RCC) nine years ago. During follow-up a pancreatic nodule was noted suggestive of a neuroendocrine tumor and the von Hippel-Lindau syndrome had to be ruled out. The fine-needle aspiration biopsy (FNAB) guided by ultrasound (US) of the thyroid nodule was inconclusive and a hemithyroidectomy and isthmectomy were performed. Histological examination revealed metastasis of a clear cell carcinoma. Discussion RCC disseminates in an unpredictable manner and can show late recurrences. Although secondary involvement of the thyroid gland by RCC is rare, it is still one of the more common neoplasms to metastasize to this site. There are no specific clinical features and few characteristic findings of metastatic thyroid carcinoma on imaging studies. FNAB is a useful procedure to diagnose metastatic thyroid cancer, but one should remain suspicious when the result for malignant cells is negative or indeterminate. After thyroidectomy the diagnosis of RCC is confirmed immunohistochemically. There is a clear survival benefit if a surgical approach to the thyroid metastasis is chosen. Conclusion Thyroid metastasis should be considered in patients with a thyroid nodule and positive history for RCC.
Collapse
|
|
20
|
Kobayashi K, Hirokawa M, Yabuta T, Fukushima M, Masuoka H, Higashiyama T, Kihara M, Ito Y, Miya A, Amino N, Miyauchi A. Metastatic carcinoma to the thyroid gland from renal cell carcinoma: role of ultrasonography in preoperative diagnosis. Thyroid Res 2015; 8:4. [PMID: 25802554 PMCID: PMC4369826 DOI: 10.1186/s13044-015-0016-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/02/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with metastases to the thyroid from renal cell carcinoma (RCC) that need surgical management are not many and unfamiliar to clinicians and thyroid endocrinologists. Therefore, little information is available on ultrasonographic features of metastatic carcinoma in the thyroid. The strategic value of ultrasound in preoperative surgical planning for patients with thyroid nodules has become increasingly appreciated. The purposes of this article are to clarify the ultrasound characteristics of metastatic carcinoma to the thyroid from RCC by evaluating many patients in one institute, and to investigate the role of ultrasonography in preoperative diagnosis. METHODS Ten patients with these carcinomas who had undergone surgical management were investigated clinically and ultrasonographically. Ultrasonographic features to be evaluated were the form of involvement in the thyroid, size, shape, pattern, calcifications, vascularity, and tumor thrombus. Clinical features were previous history of RCC, serum thyroglobulin levels, cytology, preoperative diagnosis, and surgery. RESULTS Ultrasonographic features of these carcinomas were more likely to involve a solitary, irregular, and solid without calcifications, and prominent intra-tumoral vascularity and tumor thrombus in the vein. These patients tended to be older, and to have relatively late recurrence in the thyroid, RCC in the right kidney as the primary site, and relatively low serum thyroglobulin levels. CONCLUSIONS Metastatic carcinomas to the thyroid from RCC presented highly characteristic features on ultrasonography. These ultrasonographic features combined with cytological findings and previous medical history of RCC can provide the optimal process for the preoperative diagnosis of such patients.
Collapse
Affiliation(s)
- Kaoru Kobayashi
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | | | - Tomonori Yabuta
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | | | - Hiroo Masuoka
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | - Takuya Higashiyama
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | - Minoru Kihara
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | - Yasuhiro Ito
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | - Akihiro Miya
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | - Nobuyuki Amino
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| | - Akira Miyauchi
- Kuma Hospital, 8-2-35 Shimoyamate-dori, , Chuo-ku Kobe-City, 650-0011 Japan
| |
Collapse
|
|
21
|
Beutner U, Leowardi C, Bork U, Lüthi C, Tarantino I, Pahernik S, Wente MN, Büchler MW, Schmied BM, Müller SA. Survival after renal cell carcinoma metastasis to the thyroid: single center experience and systematic review of the literature. Thyroid 2015; 25:314-24. [PMID: 25491306 DOI: 10.1089/thy.2014.0498] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Renal cell carcinoma can metastasize to uncommon sites, for example, the thyroid gland where metastases are rarely found. To determine the patient survival and the time between cancer diagnosis and thyroid metastasis, we analyzed a large patient cohort from our hospital records and performed a systematic review. PATIENTS AND METHODS Patients diagnosed between 1978 and 2007 with thyroid metastases from renal cell carcinoma were retrospectively identified from the hospital database. A systematic literature search was performed for publications describing at least three cases of thyroid metastasis from renal cell carcinoma. Case data from the identified studies were collected and used to determine the survival data. RESULTS We identified 34 patients (19 females) from our hospital records with a mean age of 67 years (range, 33-79) when thyroid metastasis was diagnosed. Median time to primary metastasis after resection of renal cell carcinoma was 6.5 years (range, 0-25) with a single case of synchronous metastasis. Median survival after primary metastasis was 4.7 years (95% confidence interval [CI]: 1.8-7.6). The systematic review included 32 studies with 285 patients. Case data could be extracted for 202 patients. Median time to thyroid metastasis (without synchronous cases) was 8.8 years (95% CI: 7.5-10.1). Median actuarial survival after thyroid metastasis was 3.4 years (95% CI: 2.2-4.6). Total thyroidectomy was not associated with a better survival compared to partial thyroidectomies. CONCLUSIONS Time to thyroid metastasis of renal cell carcinoma can be very long, and survival after thyroidectomy is favorable compared to metastasis to other sites.
Collapse
Affiliation(s)
- Ulrich Beutner
- 1 Department of Surgery, Kantonsspital St. Gallen , St. Gallen, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Krishnamurthy A, Deen S, Ramshankar V, Majhi U. Palliative thyroidectomy in the setting of a metastatic renal cell carcinoma. Indian J Nucl Med 2014; 29:273-5. [PMID: 25400374 PMCID: PMC4228598 DOI: 10.4103/0972-3919.142646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A secondary neoplasm of the thyroid gland is a distinctly uncommon cause of thyroid enlargement. These tumors mimic primary thyroid gland tumors and often lead to diagnostic difficulties. We report an interesting case of secondary thyroid tumor coexisting with a micropapillary carcinoma in an elderly male patient following a radical nephrectomy done 15 years prior for a renal cell carcinoma (RCC). Interestingly, the previously described coincidental association of thyroid and pancreatic metastases in a metastatic RCC was also noted in our patient as was demonstrated in the positron emission tomography-computed tomography which was done as part of the metastatic workup. This association needs to be further explored as also the role of palliative thyroidectomy in the setting of a metastatic RCC. The possibility of metastatic RCC should be kept as a differential during the course of the evaluation of clear cell renal tumor of the thyroid gland.
Collapse
Affiliation(s)
- Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Suhail Deen
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | | | - Urmila Majhi
- Department of Pathology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| |
Collapse
|
|
23
|
Dušková J, Rosa P, Přeučil P, Svobodová E, Lukáš J. Secondary or second primary malignancy in the thyroid? metastatic tumors suggested clinically: a differential diagnostic task. Acta Cytol 2014; 58:262-8. [PMID: 24903466 DOI: 10.1159/000360805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 02/23/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the algorithms employed to explore the suggestion or consideration of metastatic malignancy in the thyroid. STUDY DESIGN Thirty-seven cases with a history of malignancy (n = 21) and/or uncommon fine-needle aspiration biopsy (FNAB) findings (n = 37) were reviewed and reclassified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). RESULTS The group was heterogeneous in terms of the final histopathology results: the suggested metastasis was confirmed in only half of the cases (11/21; 52.4%). Primary thyroid malignancies were mostly nondifferentiated, medullary, or rare. However, 3 papillary carcinomas (the less common variants) were also found. Finally, 5 out of 37 cases were surprisingly benign upon histopathological investigation (uncommon repair and fibrotizing Hashimoto thyroiditis). CONCLUSIONS The metastatic nature of thyroid gland nodule(s) must be considered in cases of generalization of malignancy and/or uncommon FNAB findings. We must be as open-minded as possible from the outset. Additional techniques are helpful if available - cytoblock and immunocytochemistry can contribute substantially. Morphological comparisons with the previous malignancy are recommended whenever possible. To avoid overtreatment, cases without precise typing should not be classified as TBSRTC diagnostic category VI - malignant, but should remain in TBSRTC diagnostic category V - suspicious for malignancy. Repeated FNAB to enable additional techniques may be suggested.
Collapse
Affiliation(s)
- Jaroslava Dušková
- Cytopathology Laboratory, Institute of Pathology, 1st Medical Faculty, Charles University and Medical College, Prague, Czech Republic
| | | | | | | | | |
Collapse
|
|
24
|
Montero PH, Ibrahimpasic T, Nixon IJ, Shaha AR. Thyroid metastasectomy. J Surg Oncol 2013; 109:36-41. [PMID: 24122778 DOI: 10.1002/jso.23452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 09/10/2013] [Indexed: 12/14/2022]
Abstract
Metastases to the thyroid gland are uncommon. Renal, lung, breast, and colon cancer and melanoma are the most common primary diseases implicated. Few retrospective series have been reported. Treatment decisions must be individualized, and will depend on the state of systemic disease. Selected patients could benefit from surgical treatment. Although most patients selected for surgery will not be cured, the aim of surgery is to avoid the complications of uncontrolled central neck disease.
Collapse
Affiliation(s)
- Pablo H Montero
- Head and Neck Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer, New York, New York
| | | | | | | |
Collapse
|
|
25
|
Narine N, Thiryayi SA, Perera DM. Fine-needle aspiration cytology of renal clear cell carcinoma metastatic to the thyroid gland. Diagn Cytopathol 2013; 41:843-5. [DOI: 10.1002/dc.23004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/17/2013] [Accepted: 04/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Nadira Narine
- Central Manchester University Hospitals NHS Foundation Trust Manchester, M13 9WL; United Kingdom
| | - Sakinah A Thiryayi
- Central Manchester University Hospitals NHS Foundation Trust Manchester, M13 9WL; United Kingdom
| | - Dona Marina Perera
- Central Manchester University Hospitals NHS Foundation Trust Manchester, M13 9WL; United Kingdom
| |
Collapse
|
|
26
|
Metastases of renal cell carcinoma to the thyroid gland with synchronous benign and malignant follicular cell-derived neoplasms. Case Rep Oncol Med 2013; 2013:485025. [PMID: 23878753 PMCID: PMC3639688 DOI: 10.1155/2013/485025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/27/2013] [Indexed: 02/02/2023] Open
Abstract
Clear cell renal cell carcinoma (CCRCC) is the most common origin for metastasis in the thyroid. A 51-year-old woman was referred to our hospital for a subcarinal lesion. Ten years before, the patient had undergone a nephrectomy for CCRCC. Whole-body fluorodeoxyglucose positron emission tomography revealed elevated values in the thyroid gland, while the mediastinum was normal. An endoscopic ultrasonography-guided fine-needle aspiration biopsy of the mediastinal mass was consistent with CCRCC, and this was confirmed after resection. The thyroidectomy specimen also revealed lymphocytic thyroiditis, nodular hyperplasia, one follicular adenoma, two papillary microcarcinomas, and six foci of metastatic CCRCC involving both thyroid lobes. Curiously two of the six metastatic foci were located inside two adenomatoid nodules (tumor-in-tumor). The metastatic cells were positive for cytokeratins, CD10, epidermal growth factor receptor, and vascular endothelial growth factor receptor 2. No BRAF gene mutations were found in any of the primary and metastatic lesions. The patient was treated with sunitinib and finally died due to CCRCC distant metastases 6 years after the thyroidectomy. In CCRCC patients, a particularly prolonged survival rate may be achieved with the appropriate therapy, in contrast to the ominous prognosis typically found in patients with thyroid metastases from other origins.
Collapse
|
|
27
|
Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398:347-75. [PMID: 23456424 DOI: 10.1007/s00423-013-1057-6] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. METHODS The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. RESULTS The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. CONCLUSION These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
Collapse
Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
28
|
["Diagnostic" interscalene plexus block]. Anaesthesist 2012; 61:143-4, 147. [PMID: 22354402 DOI: 10.1007/s00101-011-1967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 10/28/2022]
Abstract
The dedicated target region should be systematically examined before performing an ultrasound-guided nerve block so that the anatomy can be assessed and anatomic variants or pathologic findings are not missed. In the case described an ultrasound-guided interscalene plexus block was performed in a 73-year-old man. During this examination a cystic structure was detected within the thyroid gland. The further diagnostic procedure showed a metastasis of a renal cell carcinoma which had been treated by resection 10 years before.
Collapse
|
|
29
|
|
|
30
|
The use of immunohistochemistry in the diagnosis of metastatic clear cell renal cell carcinoma: a review of PAX-8, PAX-2, hKIM-1, RCCma, and CD10. Adv Anat Pathol 2010; 17:377-93. [PMID: 20966644 DOI: 10.1097/pap.0b013e3181f89400] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The diagnosis of metastatic clear cell renal cell carcinoma may be difficult in some cases, particularly in the small image-guided biopsies that are becoming more common. As targeted therapies for renal cell carcinoma are now standard treatment, the recognition and diagnosis of renal cell carcinoma has become even more critical. Many adjunctive immunohistochemical markers of renal epithelial lineage such as CD10 and RCCma have been proposed as aids in the diagnosis of metastatic renal cell carcinoma, but low specificities often limit their utility. More recently described markers (PAX-2, PAX-8, human kidney injury molecule-1, hepatocyte nuclear factor-1-β, and carbonic anhydrase-IX) offer the potential for greater sensitivity and specificity in this diagnostic setting; however, knowledge of their expected staining in other neoplasms and tissues is critical for appropriate use. In this review, we discuss the most widely used immunohistochemical markers of renal lineage with an emphasis on their sensitivity and specificity for metastatic clear cell renal cell carcinoma. Subsequently, we present a variety of organ-specific differential diagnostic scenarios in which metastatic clear cell renal cell carcinoma might be considered and we propose immunopanels for use in each situation.
Collapse
|