Abstract
Papillary thyroid cancer (PTC) frequently metastasizes to the cervical lymph region and less often to the lung and bone. Metastasis to the skeletal muscles from PTC is extremely rare, especially concurrent lung and skeletal muscle metastases. The present study reports the case of a 31-year-old man with synchronous metastasis to the skeletal muscle and lung from PTC, six years following total thyroidectomy and consecutive 131Iodine treatments. Magnetic resonance imaging (MRI) revealed a 1.7×1.2×1.5 cm mass in the left gastrocnemius muscle, indicating a neurogenic tumor. The mass was subsequently resected and confirmed via histopathology to be metastatic PTC. We propose that, in the follow-up of patients with PTC, the measurable serum thyroglobulin level, whole body scan and other imaging modalities including MRI or positron emission tomography/computed tomography, must be closely monitored for potential distant metastases, particularly in cases of PTC with aggressive pathological behavior.
Highlights
The majority of thyroid cancers (90%) are differentiated thyroid cancers (DTC), a term which includes both papillary and follicular cancer [1]
A retrospective review of the literature revealed only two case reports of muscle metastases arising from papillary thyroid cancer (PTC) [11,12]
The aggressiveness of the tumor led to mortality eight years following total thyroidectomy
Summary
The majority of thyroid cancers (90%) are differentiated thyroid cancers (DTC), a term which includes both papillary and follicular cancer [1]. Among DTC, the incidence of papillary thyroid cancer (PTC) was 7.9 per 100,000 individuals, the mortality rate was ~0.4 per 100,000 individuals and the overall. An ultrasound (US) of the patient's neck revealed hypoechoic multinodules with microcalcification in the bilateral thyroid, the largest of which was located in the left lobe (~3.0 cm). NA, not available; PTC, papillary thyroid carcinoma; TX, Tumor size was not available; y, years. Histopathology revealed the mass to be a metastatic papillary tumor (Fig. 2B and C), and immunohistochemical examination showed that the cells were positive for thyroid transcription factor‐1 (TTF‐1) (Fig. 2D), indicating gastrocnemius muscle metastasis from PTC. CT imaging of the chest revealed innumerable, moderately well‐circumscribed nodules in the lung with high 131Iodine uptake, indicating tumor metastases. The patient's Tg levels decreased to 40.6 ng/ml (normal range,
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