Abstract
Introduction: The term collision tumor refers to the coexistence of two histologically distinct neoplastic tumors within the same mass. Collision tumor of the thyroid (also referred to as tumor-to-tumor metastasis) with metastatic colorectal carcinoma to a preexisting thyroid adenomatoid nodule is rare. Preoperative diagnosis of this disorder is exceedingly difficult. This report highlights the rare occurrence of a tumor-to-tumor metastasis of colorectal cancer to a preexisting thyroid adenomatoid nodule unveiled in real time by serial positron emission tomography CT scans (PET/CT). Since cytological diagnosis of these lesions is often insufficient, we present a stepwise diagnostic approach with a combination of investigations in the preoperative setting. The patient management is reviewed together with a rationalized use of targeted therapy based on the genetic status of the tumor. Methods: Ultrasound (US)-guided fine needle aspiration (FNA) biopsies of the collision tumor of thyroid were performed and analyzed for cytologic, immunologic, and molecular tumor phenotyping. KRAS gene analysis of the metastatic lesion was also performed. Results: The samples revealed adenocarcinoma of the colon (Tg-negative, TTF-1-negative, HBME-1-negative, galectin-3 negative, CEA-positive, CK-20 positive) intense glucose transporter-1(GLUT-1) expression and KRAS positivity. The patient was then brought to surgery for a left hemithyroidectomy and ipsilateral central compartment node dissection. Final histology revealed metastatic colonic carcinoma, invading the benign adenomatoid nodule. His recovery was uneventful and the post-op chemotherapeutic regimen was guided by the KRAS analysis of the tumor. Conclusion: Once a collision tumor of the thyroid gland is suspected on PET/CT, the lesion should be corroborated by sonography of the thyroid gland. FNA with combined cytological, immunocytochemical and when necessary KRAS gene analysis can lead to a timely diagnosis and a treatment plan. In the context of limited systemic malignant disease and good performance status, palliative thyroidectomy with or without combined chemotherapy may control local disease and prevent tracheal invasion.
Highlights
The term collision tumor refers to the coexistence of two histologically distinct neoplastic tumors within the same mass
Once a collision tumor of the thyroid gland is suspected on positron emission tomography CT scans (PET/CT), the lesion should be corroborated by sonography of the thyroid gland
Cytology and immunocytochemistry performed on the third fine needle aspiration (FNA) specimen obtained from left thyroid nodule revealed metastatic colonic carcinoma (Tg-negative, TTF-1-negative, HBME-1-negative, galectin-3 negative, carcinoembryonic antigen (CEA)-positive, and CK-20 positive)
Summary
The term collision tumor refers to the coexistence of two histologically distinct neoplastic tumors within the same mass. Collision tumor of the thyroid ( referred to as tumor-to-tumor metastasis) with metastatic colorectal carcinoma to a preexisting thyroid adenomatoid nodule is rare. Preoperative diagnosis of this disorder is exceedingly difficult. Collision tumor of the thyroid ( referred to as tumor-to-tumor metastasis) of a colorectal carcinoma to a preexisting thyroid tumor is exceedingly rare Preoperative diagnosis of this disorder is difficult but aided by a composite of investigations including: structural/functional imaging and fine needle aspiration (FNA)-based cytologic, immunologic, and molecular tumor phenotyping [1,2,3,4]. This report demonstrates the very rare tumor-to-tumor metastasis of a colorectal carcinoma to a pre-existing thyroid adenomatoid nodule unveiled in real time. Palliative hemithyroidectomy allowed for prevention of possible tracheal invasion and rationalized use of targeted therapy based on the KRAS status of the colorectal lesion
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