Thyroid Cancer Presenting Research Articles

Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer

BackgroundDifferentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common.Case PresentationA 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease.ConclusionDespite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.

SUN-486 Unusual Presentation of Metastatic Follicular Thyroid Cancer

Distant metastasis of follicular thyroid cancer to the bone has been well documented. However, spinal cord compression as the initial presentation of metastatic follicular thyroid cancer without any thyroid symptoms is relatively rare. Here we discuss such a case. A 78-year-old female with history of HTN and melanoma presented to the ED with a 1-month history of middle back pain that progressed to lower extremity weakness, numbness, and inability to ambulate. MRI showed a T7 vertebral mass with cord compression and edema. Metastatic work up was unremarkable except for incidental bilateral thyroid nodules, the largest on the right lobe, at 1.6 cm, with peripheral calcifications. The patient underwent T6-T7 laminectomy with vertebral decompression, partial colpectomy, and T4-T10 fusion. Pathology of the thoracic vertebral mass was positive for CAM 5.2, cytokeran 7, TTF-1, and PAX8 consistent with either metastatic pulmonary adenocarcinoma or thyroid carcinoma. The patient denied shortness of breath, dysphagia, hoarseness, or neck tenderness. She had no personal history of hyperthyroidism or hypothyroidism, or radiation exposure. She also did not have any family history of thyroid cancer. Laboratory work up was significant for TSH of 3.71 mcU/mL (0.4-4.0 mcU/mL), Free T4 1.56 ng/dL (0.7-1.9 ng/dL), thyroglobulin (Tg) 6940 ng/mL (1.6-55.0 ng/mL), and thyroglobulin antibody (Tg Ab) 20 IU/mL (0-115 IU/mL). FNA of the right thyroid nodule showed follicular neoplasm with very similar morphological features to the epidural pathology, favoring a follicular carcinoma. She underwent total thyroidectomy. Pathology showed a 1.6 x 1.1 cm follicular carcinoma with capsular and angiolymphatic invasion, but with uninvolved margins of resection. TNM staging was pT1b, pNx, pM1. She was ablated with 109 mCi of I-131 after withdrawal therapy. Whole body scan after treatment revealed radioiodine avid metastatic disease at T7 and activity in the thyroid bed compatible with residual thyroid tissue. Patient completed 10 fractions of external beam radiotherapy to the spine for a total of 30 Gy. Three months follow up lab work showed Tg 580 ng/mL and negative Tg Ab with a suppressed TSH. Thyroid bed ultrasound did not show any residual tissue or abnormal lymph nodes. Ten-year survival rates in patients with bony metastatic differentiated thyroid cancer range from 13-21% (1). Metastatic thyroid carcinoma should be considered in the differential diagnosis of every patient with new onset bony metastasis and thyroglobulin should be considered as a tumor marker in the initial work up. Research shows increased survival with I-131 avidity and complete bone metastasis resection (1). 1. Ramadan, Sami et al. “Spinal metastasis in thyroid cancer.” Head & neck oncology vol. 4 39. 25 Jun. 2012, doi:10.1186/1758-3284-4-39

SUN-921 Indolent Presentation of Medullary Thyroid Cancer in a Patient with MEN Type 2B Due to a Germline RET M918T Mutationo

Background: MEN type 2B is rare and most commonly due to a germline methionine-to-threonine substitution at codon 918 (M918T) of the RET proto-oncogene. Medullary thyroid cancer (MTC) occurs in 100% of the patients affected with the mutation. This mutation is considered the highest risk and is typically associated with aggressive disease and worse overall survival. We describe a case of a late diagnosis of MEN 2B in a patient and his son, both with a relatively indolent presentation of MTC. Clinical Case: A 39-year-old man presented to an outside institution with difficult to control hypertension, headaches and anxiety and was found to have bilateral pheochromocytomas (left, 5.8 x 5.5 x 3.8 cm and right, 9 x 5.2 x 7.3 cm). Upon presentation to our institution, he was noted to have classic phenotypic features of MEN 2B with a marfanoid habitus and multiple mucosal neuromas. Genetic testing confirmed RET M918T mutation. His family history was negative for similar features in his parents and siblings. However, one of his three children, age 12, had similar phenotypic features and was found to have the same mutation. The patient subsequently underwent a successful bilateral adrenalectomy and pathology confirmed pheochromocytomas. Thyroid ultrasound showed multiple nodules with calcifications but no lateral nodal metastases. Calcitonin and carcinoembryonic antigen (CEA) levels were elevated (170 pg/mL, normal ≤10, and 180.4 ug/L, normal <3.8, respectively). He underwent a total thyroidectomy and bilateral central node dissection, with pathology confirming bilateral MTC (2.7 cm and 1.0 cm), metastatic in 4 of 10 positive lymph nodes (largest focus 2 mm). Whole body PET/CT post-operatively did not show metastatic disease. The patient’s son also had multiple thyroid nodules on ultrasound without lateral nodal metastases and elevated calcitonin and CEA levels (3015 pg/ml, normal ≤10, and 433 ng/mL, normal <2.5, respectively). MRI of the abdomen and pelvis was negative for pheochromocytomas. He underwent total thyroidectomy and bilateral central neck dissection, with pathology showing bilateral MTC (2.7 cm and 1.0 cm) with 0 of 14 positive lymph nodes. For both the patient and his son, calcitonin and CEA levels normalized following thyroidectomy and surveillance over a year later reveals no evidence of disease. Conclusion: Early diagnosis of MEN type 2B is important as MTC develops early in life and is the leading cause of death in these patients. When diagnosed early, prophylactic thyroidectomy in childhood is indicated and can improve long-term survival. There are salient phenotypic features associated with this disease which were unfortunately not recognized early in this patient and his son. Fortunately, their MTC presentations appear to be relatively indolent despite their late diagnoses, and they will continue to be closely monitored for recurrent disease.

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

Metastatic Thyroid Cancer Presenting as Renal Cortical Mass

The authors present a rare case of primary diagnosis of metastatic, differentiated thyroid cancer presenting as a solitary, large renal mass. Renal cortical masses which represent metastatic primary malignancies are often small, multifocal, and in the setting of active malignancy. Surgical excision of this patient's renal mass demonstrated the unexpected diagnosis and subsequent endocrine surgical intervention.

Papillary Thyroid Cancer Presenting as a Uterine Metastasis

The objective of this case is to report the highly unusual occurrence of uterine metastasis from a papillary thyroid cancer (PTC). PTC is rarely associated with distant metastases and typically spreads to bone or pulmonary tissue. In this case a 69-year-old female presented with post menopausal bleeding (PMB). She was otherwise well with no significant medical history or regular medications and reported no family history of thyroid disease. A subsequent endometrial polyp was identified as the cause of her PMB and removed. In addition as part of her clinical examination a goitre was noted and radiological imaging (including an ultrasound, magnetic resonance imaging of the neck and computer tomography of thorax, abdomen and pelvis) was performed and demonstrated a large thyroid mass which extended retrosternally and caused tracheal narrowing. The remainder of the imaging was unremarkable. The endometrial biopsy demonstrated morphological features of PTC. BRAF V600 mutation was not detected. A subsequent core biopsy of the mediastinal mass displayed morphological and immunohistochemical characteristic similar to that of the endometrial polyp. In combination this confirmed a diagnosis of primary papillary thyroid carcinoma. Surgical treatment included a total thyroidectomy, sternotomy and left neck dissection. Lymph node involvement was demonstrated at levels II-VI. Despite radioactive iodine and the use of tyrosine kinase inhibitors this lady died from complications of her disease. J Endocrinol Metab. 2019;9(4):113-116 doi: https://doi.org/10.14740/jem591

Metastatic papillary thyroid cancer presenting with a recurrent necrotic cystic cervical lymph node

SummaryWe report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst. A 55-year-old woman presented with a 3-month history of a right-sided upper neck mass following an upper respiratory tract infection. Past medical history includes a right-sided nephrectomy secondary to a benign renal tumor and hypertension. She was evaluated by Otolaryngology, and fine-needle aspiration was performed. The mass recurred 2 months following aspiration. Ultrasound of the neck showed a 2.2 × 1.4 × 1.9 cm right cervical lymph node with a small fatty hilum but a thickened cortex. Neck computed tomography (CT) scan showed a well-defined 2.3 cm mass in the right upper neck corresponding to a necrotic cervical lymph node at level IIA. It also revealed a 7 mm calcified left thyroid nodule. Cytology revealed a moderate collection of murky fluid with mildly atypical cells presumed to be reactive given the clinical history of infection. The cyst had re-grown 2 months following aspiration. Excisional biopsy was performed and revealed metastatic classic papillary thyroid carcinoma (PTC). Subsequently, a total thyroidectomy and right neck dissection was performed. Pathology confirmed metastatic unifocal classic PTC of the right thyroid lobe and two lymph node metastases out of a total of 17 resected lymph nodes. The patient underwent radioactive iodine ablation. Subsequent I-131 radioiodine whole-body scan showed no evidence of metastases. In conclusion, metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.Learning points:Metastatic PTC should be considered in the differential diagnosis of a recurrent solitary cystic cervical lymph node.A dedicated thyroid ultrasound is the preferred modality for identifying thyroid lesion over computed tomography.There is a risk of non-diagnostic cytology following FNA for cystic neck lesions, largely predicted by the cyst content of the nodule.

SUN-598 Neck Pain as an Initial Presentation of Medullary Thyroid Cancer

Background: Neck pain is common in adults and can be caused by various conditions, most commonly due to musculoskeletal disorder. Thyroid cancer is not usually considered as an etiology for neck pain. We report a patient with an initial presentation of neck pain due to medullary thyroid cancer (MTC). Case Presentation: A 40-year-old female without significant medical history initially presented to her primary care provider with 12 months of left-sided neck pain, point tenderness in the lower neck, and minimal improvement in pain despite multiple courses of physical therapy for presumed musculoskeletal pathology. She noted recent hoarseness, but no esophageal, respiratory, or endocrine symptoms. On physical examination, a discrete left-sided thyroid nodule was palpated. Thyroid ultrasound confirmed a 1.0 x 1.0 x 1.5 cm solid, hypoechoic, taller than wide nodule with irregular borders in the left thyroid lobe. Thyroid function tests including TSH and free T4 were normal. Fine needle aspiration (FNA) of the nodule showed numerous malignant appearing cells with background amyloid suggestive of MTC. Serum calcitonin and CEA were found to be elevated to 206 pg/mL and 8.5 ng/mL, respectively (reference ranges 0-5 pg/mL and 0.2-4.7 ng/mL). Calcium stimulation testing was performed with elevation of calcitonin to 413 pg/mL. Further evaluation disclosed left-sided vocal fold paresis. She was scheduled for total thyroidectomy with central and left lateral neck lymph node dissections and referred for genetic testing. Discussion: Neck pain is an uncommon presentation of thyroid cancer with a reported prevalence of 22% in patients with MTC, 6% with papillary thyroid cancer (1), and 26% in anaplastic thyroid cancer (2). Diagnosis of MTC is usually made by FNA and confirmed with elevated serum calcitonin. In indeterminate cases, calcium stimulation testing can be a useful adjunct to confirm MTC. Given its association with familial tumor syndromes, genetic testing is recommended in all new MTC cases to identify at risk families for early intervention, potentially to include prophylactic thyroidectomy. MTC patients also require serial calcitonin monitoring after surgery to identify recurrences and residual disease. It is important to examine the neck and thyroid gland carefully in patients with neck pain.

SUN-608 A Rare Miliary Tuberculosis-Like Presentation of Papillary Thyroid Cancer: A Case Report with Literature Review

Papillary thyroid cancer (PTC) is the most common thyroid cancer with a very favorable prognosis [1]. It commonly presents as a palpable thyroid nodule or an incidental finding of thyroid nodule(s) seen on imaging. The most common site of metastases in PTC is lung, however, the incidence is very low. Presence of metastasis can drastically affect the prognosis of PTC [2]. We discuss here a case of an asymptomatic 34-year-old male, who initially presented with positive tuberculin skin test and was found to have diffuse micronodular pulmonary disease on chest imaging. Initially being diagnosed with pulmonary TB, he received 6 months of empiric anti-tuberculous therapy, although, repeated sputum and blood cultures for acid-fast bacilli remained negative. However, patient had no improvement of pulmonary lesions on interval imaging. Another interesting incidental finding, seen on lung CT, was the presence of multinodular appearance of the thyroid gland which prompted further imaging of the neck. CT scan of the neck showed multiple enhancing necrotic masses in the right thyroid gland with similar lesions in cervical lymph nodes. Considering the patient’s preliminary diagnosis of pulmonary TB, these lesions were thought to be secondary to tuberculosis. However, given that different types of thyroid malignancies can have a similar presentation, further workup was initiated. Subsequent FNA was positive for PTC on the right thyroid nodule. A total thyroidectomy with neck dissection was performed and confirmed the presence of a 2 cm PTC with cervical lymph node metastases. Post-operative non-stimulated thyroglobulin was very high at 2858. Thyroglobulin antibody was negative. The post radioactive iodine therapy (RAI) whole body scan (WBS) showed impressive bilateral lung uptake. Widespread pulmonary nodules, similar to that seen in miliary TB, is a rare initial presentation of PTC. However, as our case highlights, the added presence of thyroid nodules should prompt further investigation to rule out PTC as the cause of pulmonary lesions. 1. Aschebrook-Kilfoy, B., et al., Thyroid cancer incidence patterns in the United States by histologic type, 1992-2006. Thyroid, 2011. 21(2): p. 125-34. 2. Lang, B.H., et al., Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg, 2007. 245(3): p. 366-78.

SUN-605 A Case of Metastatic Papillary Thyroid Cancer Presenting as a Skin Lesion

Introduction: The most common sites of thyroid cancer metastases include the lymph nodes, lungs, bone, and occasionally the brain. Skin metastases are rare and the most common location that has been reported is the scalp (1-3). When they do occur, skin metastases usually occur in the setting of locally invasive thyroid cancer or widely disseminated neoplastic disease (4). Case: A 69 year old male with a history of coronary artery disease and thyroid surgery (done for an unknown, benign condition, as per patient) presented to our dermatology clinic with an exophytic, violaceous skin lesion (1 x 0.5 cm) below his left clavicle. He noticed the lesion 3 years ago and noted that it had enlarged over the 3 months prior to presentation. An excisional biopsy of the lesion was consistent with papillary thyroid carcinoma positive for TTF, CK7, and thyroglobulin. The patient was subsequently evaluated in our endocrine clinic at which time a thyroid ultrasound revealed a 4 mm right thyroid nodule and confirmed prior history of a left hemithyroidectomy. He underwent completion thyroidectomy and radioactive iodine ablation therapy with 80 mci of I-131. Surgical pathology showed no carcinoma of the right thyroid lobe. A post-RAI whole body scan demonstrated no evidence of metastatic disease and a neck ultrasound did not reveal any thyroid remnant tissue or abnormal lymph nodes. An initial pre-operative Tg level was 31.5 ng/ml that decreased to 3.2 ng/ml five months post-RAI. The Tg Ab remains undetectable. Currently, he is without structural evidence of disease. We have recommended a TSH goal of less than 0.5 uIU/mL and plan to monitor the Tg levels with a 1 year follow-up whole body scan. Conclusion: We present an unusual case of metastatic papillary thyroid cancer manifesting as a dermatologic lesion in the absence of local concurrent or advanced metastatic disease. It is important to consider thyroid carcinoma in the differential diagnosis of atypical skin lesions.

SUN-606 Thyroid Cancer Presenting As Acute Limb Ischemia

INTRODUCTION: Cardiac metastases are present in up to 20% of patients with extra-cardiac malignancies and are 40 times more common than primary cardiac tumors. However, thyroid cancer metastatic to the heart is rare. We report a case of mixed follicular and papillary thyroid carcinoma with the presence of anaplastic features presenting with cardiac metastasis. CASE: A 52-year old female non-smoker was admitted with right arm ischemia. Two years earlier, she had been diagnosed with thyroid cancer and underwent total thyroidectomy. Surgical pathology at the time revealed multifocal follicular and papillary thyroid cancer with focal anaplastic changes and positive central lymph nodes. She was treated with 150mCi RAI for remnant ablation, with the post treatment whole-body scan revealing radiotracer activity in the neck but no scintigraphic evidence of distant metastases. She was subsequently lost to follow-up. At the time of admission, she was found to have acute limb ischemia due to axillary artery thrombosis and underwent fasciotomy and embolectomy. Chest CT revealed multiple cavitary lung lesions and a left ventricular mass with adherent thrombus. Biopsy of the lung lesions confirmed metastatic poorly differentiated thyroid cancer (immunohistochemical staining positive for Pax8, TTF-1 and P40, but negative for thyroglobulin). PET scan showed multiple hypermetabolic lesions, including bilateral pulmonary nodules, right hilar adenopathy, a left ventricular mass, and right hepatic lobe lesion. Mutational analysis showed BRAF V600E mutation. The patient is receiving salvage chemotherapy with dabrafenib/ trametinib. DISCUSSION: While rare, follicular carcinoma is the most common thyroid cancer with cardiac metastasis, mostly involving the central veins and right atrium. Papillary thyroid cancer tends to metastasize through the lymphatic system and involve the right side of the heart. The aggressive behavior of our patient’s tumor, with involvement of the left heart suggestive of vascular metastasis, is likely due to the concurrent presence of anaplastic de-differentiation. Anaplastic carcinomas are highly aggressive neoplasms and 71% are said to occur simultaneously with a well-differentiated thyroid cancer. About 50% of patients diagnosed with anaplastic thyroid cancer have metastatic disease at the time of diagnosis and another 25% develop metastasis during the course of disease. The prognosis is very poor with median survival ranging from 4-12 months.

SUN-617 Metastatic Papillary Thyroid Cancer Presenting with Vertebral Fracture

: Of the major differentiated Thyroid malignancies, Papillary carcinoma has the highest incidence, representing 80% of cases and is most commonly diagnosed between the 3rd and 6th decade of life. Most commonly discovered as an asymptomatic thyroid nodule, Papillary carcinoma, due to its unencapsulated nature, preferentially invades local lymph nodes over hematogenous spread. Distant metastases are rare of Papillary carcinoma and even more unusual as the presenting symptom.Here we present the case of a 73 year old Caucasian Female who presented to the ED with 3 months of constant progressively worsening lower back pain. She reports associated pain into her right lateral thigh and tingling sensations over the left lateral thigh. Patient denied bladder/bowel dysfunction or saddle anesthesia. To manage the pain, our patient had been taking a full dose aspirin and was seeing a chiropractor who had given her the diagnosis of herniated disks from xray radiography. Increased severity of her pain had brought her into the ED. On physical exam, our patient had point tenderness over her lumbar spine, without any motor sensory defects. ED CT scan demonstrated a comminuted compression fracture of her L3 spine with bilateral neural forminal compromise. MRI the following day confirmed the findings. Intraoperatively during correction of the compression fracture, biopsy of the bone was sent to for analysis. The sample stained positive for TTF, thyroglobulin and PAX-8 all consistent with metastatic thyroid cancer. In the following days, our patient had an Ultrasound that confirmed a 1.6cm nodule in the right thyroid lobe. Fine needle Aspiration confirmed the findings on biopsy. Definite treatment involved thyroidectomy and samples under microscopy showed papillary cell carcinoma of the thyroid gland. Discussion: Due to its slow course and minimal invasiveness, Papillary thyroid carcinoma has great outcomes after medical and surgical management. In 90% of cases, this cancer presents as a thyroid nodule and rarely metastasizes. Ultrasound and FNA can lead to a timely diagnosis and elective surgical management can be scheduled. The standard of care is complete thyroidectomy and follow up radioactive Iodine therapy are used as definitive treatment for this malignancy, resulting in a 80% ten year survival rate. Success of management drops significantly if there is metastasis of Papillary thyroid carcinoma with some studies suggesting a 10 year survival rate at 40% and only 21% if there is bone metastasis. After the lungs and liver, bone is the 3rd most common site papillary thyroid carcinoma metastasis to. Conclusion: This presentation of spinal metastasis and the resulting compression fracture as presenting symptoms of papillary Thyroid cancer is a rare presentation of this malignancy.

Bilateral Choroidal Metastases as Initial Presentation of Widespread Follicular Thyroid Cancer

Follicular thyroid cancer (FTC) is the second most common malignancy of the thyroid gland and comprise 10-15% of all thyroid tumors; the usual mode of spread is via hematogenous dissemination with the most common sites of metastases being the lungs and bones.4 A case is presented to demonstrate the unusual presentation of follicular thyroid cancer as bilateral choroidal metastases. Although exceptional, a diagnosis of choroidal metastases should be considered in any decline in visual acuity in patients with thyroid cancer.

Papillary Thyroid Cancer Presenting as a Uterine Metastasis

The objective of this case is to report the highly unusual occurrence of uterine metastasis from a papillary thyroid cancer (PTC). PTC is rarely associated with distant metastases and typically spreads to bone or pulmonary tissue. In this case a 69-year-old female presented with post menopausal bleeding (PMB). She was otherwise well with no significant medical history or regular medications and reported no family history of thyroid disease. A subsequent endometrial polyp was identified as the cause of her PMB and removed. In addition as part of her clinical examination a goitre was noted and radiological imaging (including an ultrasound, magnetic resonance imaging of the neck and computer tomography of thorax, abdomen and pelvis) was performed and demonstrated a large thyroid mass which extended retrosternally and caused tracheal narrowing. The remainder of the imaging was unremarkable. The endometrial biopsy demonstrated morphological features of PTC. BRAF V600 mutation was not detected. A subsequent core biopsy of the mediastinal mass displayed morphological and immunohistochemical characteristic similar to that of the endometrial polyp. In combination this confirmed a diagnosis of primary papillary thyroid carcinoma. Surgical treatment included a total thyroidectomy, sternotomy and left neck dissection. Lymph node involvement was demonstrated at levels II-VI. Despite radioactive iodine and the use of tyrosine kinase inhibitors this lady died from complications of her disease. J Endocrinol Metab. 2019;9(4):113-116 doi: https://doi.org/10.14740/jem591

Bone Metastases from Thyroid Carcinoma of Follicular Origin: A Single Institutional Experience

Background/Aims: Overall, 2–13% of patients with thyroid cancer develop bone metastases (BM). In addition to decreased survival, patients with BM may present skeletal-related events (SRE) that impair the quality of life. Our objectives were to characterize clinical features, treatment approaches, and outcomes of patients with thyroid cancer and BM. Material and Methods: We identified patients diagnosed with thyroid carcinoma of follicular origin and BM followed at the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisbon, Portugal, from 1991 to 2017. SRE were defined as the need for bone irradiation, bone surgery, spinal cord compression, or pathologic fractures. Results: The final cohort consisted of 86 patients, with a median follow-up time of 54 months (IQR 22.8–82.8), mainly women (67.4%), and a median age of 64 years (IQR 53.6–71.2). BM was the initial presentation of thyroid cancer in 36.0% of the patients. Bone involvement was multiple in 59.3% of the cases. Papillary carcinoma was the most frequent histological type, present in 47.7% of the patients, of which 56.1% presented the follicular variant. SRE were found in 76.7% of the patients. The most frequent SRE was radiotherapy (66.3%). Treatment with bisphosphonates was initiated in 19.8% of the patients. The 5-year specific survival was 60%, whereas the 10-year specific survival decreased to 50%. There were no differences in 5- or 10-year specific survival regarding gender, the occurrence of SRE, or histological type. However, patients with initial radioiodine non-avid lesions had a lower 5- and 10-year specific survival (p = 0.002). Discussion: The high frequency of patients with SRE was notable. The follicular variant of papillary thyroid cancer was the variant most commonly associated with BM, reflecting a more similar behavior to follicular carcinoma than the classic variant.

Case Report: Metastatic Papillary Thyroid Cancer Presenting with a Recurrent Necrotic Cystic Cervical Lymph Node

Objective: To report a case of metastatic papillary thyroid carcinoma presenting with a recurrent right-sided cervical lymph node necrotic cyst.

Retrospective Analysis of Patients with Synchronous Primary Breast and Thyroid Carcinoma.

Breast and thyroid cancers are commonly encountered malignancies. Increased risk of breast cancer in follow-up period of thyroid cancer or vice versa has been reported. However, they have some associations, synchronous presentation of these tumors is rare. We presented 12 patients diagnosed as breast and thyroid cancer and treated at the same time. Mastectomy and thyroidectomy were performed in 19 patients at the same time. 7 patients were excluded because of benign thyroid pathology. Therefore 12 patients who had diagnosis of synchronous breast and thyroid cancer were included. Data regarding clinical, pathological, treatment and prognostic factors was retrospectively analyzed. Total thyroidectomy was performed in all patients. The mean age of patients was 54 years (min. 44-max. 70). Only one patient was male. Thyroid pathology was detected preoperatively by FDG PET-CT scan in 11 patients. Breast reconstruction was performed in three patients. The most commonly seen thyroid malignancy was papillary thyroid carcinoma. Postoperative complication rate was 33.3%. Adjuvant chemotherapy was given in 11 patients whereas one patient received adjuvant radiotherapy. Although synchronous presentation of breast and thyroid cancer is rare, surgical treatment of both of these tumors can be safely performed at the same time. Association of these tumors should be evaluated by large scaled studies.

Abstract #1099 A Rare Presentation of Non-Seminomatous Germ Cell Tumor and Papillary Thyroid Cancer

Abstract #1099 A Rare Presentation of Non-Seminomatous Germ Cell Tumor and Papillary Thyroid Cancer

Carcinoma papilar de quiste tirogloso: reporte de caso y revisión de la literatura

Introduction: Carcinomas with thyroglossal cyst localization have a low frequency, about 1% of patients present this disease; the most frequent histology is papillary thyroid carcinoma. We describe a case of papillary carcinoma of thyroglossal cyst. Clinical case: A 54-yearold man with an anterior cervical tumor of six months of evolution, not mobile, not painful, with diameters of 3 × 5 cm. Thyroid ultrasound with right thyroid nodule TIRADS 4c and suspicious adenopathies in level VI. Total thyroidectomy + Sistrunk was performed, with pathological report of multifocal conventional variant papillary carcinoma. It infi ltrated thyroid capsule and adjacent prethyroid muscles; right lobe tumor 2 × 1.5 × 1.3 cm, left lobe tumor 3.5 × 3 × 4 cm; then, I-131 dose was applied. Discussion: There is no consensus regarding the ideal treatment of papillary carcinoma in the thyroglossal cyst, although Sistrunk surgery with total thyroidectomy seems to be the most appropriate one. As this is a rare presentation of well-differentiated thyroid cancer, it could be difficult to draw conclusions with a high level of evidence for its management, but they should be guided by current guidelines of well-differentiated thyroid cancer and decisions should be made in multidisciplinary teams.

A study of clinicopathological characteristics of thyroid carcinoma at a Tertiary Care Center.

To share clinicopathological data of thyroid carcinoma from a high volume Tertiary Care Centre in East India. To share the epidemiology and clinicopathological presentation of thyroid cancer at a high volume Tertiary Care Center in East India. Retrospective observational study. Forty-two consecutive patients of thyroid neoplasm diagnosed by fine needle aspiration cytology (FNAC) and primarily underwent surgical treatment from July 2005 to June 2012 were included. Retrospective data analyses of patient's records were done. The statistical analysis was performed using Epi Info version 3.5.3. Forty-two patients underwent surgery for thyroid neoplasm. Median age of diagnosis was 39 years. It was 6 times more common in females (female:male - 6:1). Papillary carcinoma consists of 63.15%, follicular carcinoma consists of 23.68%, and medullary carcinoma and anaplastic carcinoma each consist of 5.26% of malignant cases. Out of them, lymph node metastases were seen in 17 patients (44.73%). FNAC shows positive predictive value of 89.74%. In our study, differentiated thyroid cancers were found to be more common in younger age group. Cervical lymph node metastases occur in a large number of patients. Central compartment lymph node dissection with exploration of lateral neck and modified neck dissection whenever needed is helpful in all cases of thyroid carcinoma for proper pathological staging. FNAC is rapid and efficient procedure with high positive predictive value in diagnosing thyroid neoplastic lesions.