Metastases to the thyroid gland: review of incidence, clinical presentation, diagnostic problems and surgery, our experience

A rare case of rib chondrosarcoma with purely mesenchymal cells metastases to thyroid

Metastasis to the thyroid gland is uncommon. The most common malignant tumors that metastasize to the thyroid gland include renal cell carcinoma, colorectal cancer, lung cancer, and breast cancer. Metastasis of chondrosarcoma to thyroid is extremely rare.We describe a rare case of rib chondrosarcoma metastases to the thyroid gland. We reviewed patient characteristics, histological presentations, treatments, time of recurrence on chondrosarcoma, and metastasis situation. Additionally, we review all English articles reporting cases of chondrosarcoma metastasis to the thyroid gland that have been published in Embase, PubMed, and ISI WEB of Science databases (1981-2023) in this paper.Only 7 cases of chondrosarcoma metastasis to the thyroid have been reported, including one report written in French. (Otmany et al. in Médecine Du Maghreb 53-54, 2001). We found that most patients are female adults, with compression signs or pain, most of whose metastases occurred after several years, and whom have poor prognoses. The main examinations are CT and ultrasound, the primary treatment is surgery, and the major pathological characteristic is coexistence of chondrocytes and mesenchymal cells.The case we describe here is the first report of mesenchymal chondrosarcoma metastasis to the thyroid gland with only pure mesenchymal cells and no chondrocytes. Moreover, these rare cases highlight the necessary of communication between radiologists, histopathologists, and clinicians. It is meaningful to acquaint previous malignant tumor for diagnosing the metastases to the thyroid gland.

Metastasis of Mixed Adenoneuroendocrine Carcinoma of the Uterine Cervix to Thyroid Gland

The thyroid metastasis from cervical cancer is extremely rare compared to other organs. It is sometimes difficult to distinguish primary tumors from metastases, as most metastatic thyroid nodules are asymptomatic. In this case, a 54-year-old woman had undergone radical hysterectomy due to cervical tumor of stage IB1 mixed adenoneuroendocrine carcinoma (MANEC) 5 years ago. After 3 years, ultrasound examination revealed a suspicious malignant nodule in the left lobe of thyroid gland at regular postoperative follow-up. This patient had no obvious clinical symptoms. The ultrasonography (US)-guided core needle biopsy (CNB) of the thyroid nodule was performed on the patient. The immunohistochemistry analyses revealed that it was poorly differentiated small-cell neuroendocrine carcinoma (SCNEC). Subsequently, the patient underwent left hemithyroidectomy plus isthmusectomy. The postoperative pathology and immunohistochemistry, combining with clinical history, confirmed that the thyroid nodule was a metastasis from cervical MANEC. Conventional chemotherapy and regular follow-up were carried out after the operation. The patient was readmitted 1 year later for pancreatic metastatic lesions and died 1 month after surgery. Early detection of metastatic cancer is potentially helpful, and when necessary, ultrasound-guided puncture biopsy can be utilized to further diagnose metastatic thyroid cancer.

Thyroid gland: a rare site of metastasis

PURPOSE

Despite its rich vascularity, metastasis (MTS) to the thyroid tissue is unusual, ranging from 1 to 3%. This entity is not usually considered as differential diagnosis and is not included in the upfront approach in patients with thyroid nodules. Once diagnosed, treatment is controversial. The aim of this study was to evaluate diagnosis, treatment, and outcome at the end of follow-up in patients with a diagnosis of MTS to the thyroid.

METHODS

A retrospective multicenter study was designed from 1985 to 2022; 29 patients with MTS to the thyroid gland were included in the analysis.

RESULTS

Clinical presentation included the presence of a nodular goiter (65.5%), compression symptoms (17.2%), diffuse goiter (10.3%), and suspicious lymph nodes in the neck (7%). Primary tumor sites were: kidney (44.8%), breast (24.1%), lung (13.8%), neuroendocrine system (6.9%), colon (3.4%), cervix (3.4%), and ovary (3.4%). In 18/23 patients, suspicious ultrasound criteria for malignancy were described. Preoperative diagnosis was made in 23/27 patients by FNA and confirmed in 18 cases by immunohistochemistry. Seventeen patients underwent surgery. At the end of the follow-up, 19 patients had died of oncological disease, and six were alive (2/6 disease-free with isolated intrathyroidal MTS).

CONCLUSION

Renal carcinoma was the tumor that most frequently metastasized to the thyroid gland. Immunodiagnosis was a very useful tool for etiological confirmation. Patients with MTS to the thyroid gland as a unique site had a more favorable course compared to patients with multiple metastatic sites. Finally, outcomes and prognosis essentially depended on the biology of the primary tumor.

Adenocarcinoma admixed with neuroendocrine carcinoma of the cervix: A case report and review of literature

A 40-year-old Ethiopian woman presented with a six-month history of non-foul-smelling whitish vaginal discharge. She also reported a one-year history of postcoital bleeding. A pelvic examination revealed a nodular, hard, and fragile cervical mass. In addition, there were nontender, firm nodules in the epigastric, periumbilical, gluteal areas, and thyroid gland. Investigations, including abdominopelvic ultrasound, magnetic resonance imaging, fine-needle aspiration cytology, and immunohistochemistry, confirmed mixed neuroendocrine carcinoma of the cervix with metastasis to the abdominal wall, gluteal area, lumbar vertebrae, and thyroid gland. The patient was started on palliative chemotherapy. Metastatic adenocarcinoma admixed with neuroendocrine carcinoma of the cervix presents a formidable disease phenotype, characterized by complex diagnostic and therapeutic obstacles. Multidisciplinary cooperation among oncologists, radiologists, pathologists, and surgeons is required to refine treatment approaches and improve patient prognoses for this uncommon and intricate malignancy.

Ultrasonographic Findings and Prognosis of Metastases to the Thyroid Gland

Metastases to the thyroid gland (MTT) are uncommon in clinical practice. The ultrasound (US) features are easily confused with primary thyroid malignancy, Hashimoto's thyroiditis, and other thyroid diseases. Therefore, this study aimed to assess the role of US and analysis of prognosis of MTT. A total of 45 patients with MTT in the database between July 2009 and February 2022 at the Fujian Cancer Hospital were reviewed. US examinations were performed only on 20 patients, who were finally included in our study. Among the 20 patients, nine were male, and eleven were female. According to US characteristics, metastases to the thyroid gland were divided into nodular and diffuse types (17 and 3 cases, respectively). Three lesions (17.6%) had circumscribed margins, and 14 (82.4%) were uncircumscribed. Three lesions (17.6%) were regular in shape, and 14 (82.4%) were irregular. Nine metastases (52.9%) were a taller-than-wide shape, and eight (47.1%) were not a taller-than-wide shape. Ten lesions (58.8%) had rich vascularity, and seven (41.2%) had absence/not rich vascularity. The mean overall survival (OS) from the time of MTT diagnosis was 22 months (95% confidence interval: 5.95-38.05). The 1-, 3-, and 5-year OS after metastasis was 68.1%, 25.5%, and 17%, respectively. The prognosis of MTT was poor, which is closely related to the characteristics of the primary tumor and metastatic disease. The US findings and US-guided core needle biopsy may be useful in diagnosing MTT in patients with a history of the malignant tumors.

Metastatic Disease to a Concurrent Thyroid Neoplasm: A Case Series and Review of the Literature

BACKGROUND

Metastatic disease to the thyroid gland is uncommon but well-described. Metastatic disease to a concurrent primary thyroid neoplasm is a rare phenomenon. We sought to study patients with metastasis to the thyroid with a focus on the histopathologic and clinical features in tumor-to-tumor metastasis.

METHODS

We identified a series of patients with metastatic disease to the thyroid, with or without a concurrent primary neoplasm, through a search of the files of the Department of Pathology. All relevant slides were retrieved and reviewed, including routine HE and immunohistochemical stains. We performed a detailed English language literature search (1962-2022) and review to identify tumor-to-tumor metastasis involving the thyroid.

RESULTS

We identified 14 patients with metastasis to the thyroid over a 22-year period. Four patients exhibited papillary thyroid carcinoma, with metastatic spread of a different malignancy seeding into the thyroid cancer. We describe the histopathologic diagnostic process and findings, clinical management, and the clinical course of tumor-to-tumor metastasis in greater detail for these 4 patients.

CONCLUSION

Tumor-to-tumor metastasis to the thyroid is a rare event with unique histopathologic features. Our findings suggest that the phenomenon of tumor-to-tumor metastasis serves to highlight broader mechanisms of metastatic disease in general. We provide the largest-to-date and comprehensive review of the literature to identify all previous reported instances of tumor-to-tumor metastasis involving the thyroid.

Neuroendocrine neoplasm with metastasis to the thyroid: a case report and literature review

Thyroid cancer can be divided into two types according to its cellular origin, i.e., malignant tumors originating from thyroid cells and cancers that metastasize to the thyroid from other sites, the latter of which are, clinically rare. This article reports the diagnosis and treatment of a rectal neuroendocrine neoplasm metastasis to the thyroid. No similar cases have been reported before. This case suggests that when evaluating thyroid tumors, clinicians should not only carefully identify the clinical features of the tumor but also pay special attention to the patient's history of tumors, especially neuroendocrine neoplasms. For definite secondary thyroid malignancies, neck surgery is feasible if the thyroid is the only site of metastasis; otherwise, the subsequent diagnosis and treatment plan should be determined after a comprehensive evaluation of the primary tumor and patient's general condition.

Metastases to the thyroid gland: ultrasonographic findings and diagnostic value of fine-needle aspiration cytology

Introduction

In the present study, we aimed to analyze ultrasonographic findings of metastases to the thyroid and explore the role of fine-needle aspiration cytology (FNAC) in the diagnosis of metastases to the thyroid.

Methods

Twelve cases of cytologically or/and pathologically confirmed metastatic tumors of the thyroid gland were reviewed. All the primary thyroid lesions and lymphomas were excluded. The location, maximum size, echogenicity, shape, margin, presence of calcifications, vascularity, and cervical lymph nodes were assessed on ultrasonography. In addition, the results of cytology or pathology (or both) were noted retrospectively.

Results

Eight of 10 patients were diagnosed correctly with FNAC. Two cases presented with diffuse involvement in both thyroid lobes. Nine cases demonstrated a hypoechoic nodule with an irregular margin, four of which had microcalcifications. One case presented with a mixed solid and cystic mass with an oval shape. The lesions with cervical lymph nodes were found in seven cases.

Conclusion

Most metastatic thyroid cancer has similar ultrasound features to primary thyroid cancer. In some cases with atypical US features, ultrasound diagnosis should be combined with the medical history. FNAC might be helpful in the diagnosis.

An update on the current epidemiological status of metastatic neoplasms to the thyroid

Secondary tumours to the thyroid gland are uncommon with an overall prevalence of 5.9% in autopsy studies. In recent clinical series, secondary thyroid cancer is seen in only 1.9% of malignant thyroids. There is no gender predominance both overall (female to male 1.07:1) and when stratified by common histological subtypes (renal cell carcinoma, lung adenocarcinoma and colorectal adenocarcinoma). The median age of patients diagnosed with metastatic thyroid tumours in major studies ranges from 54 to 68 years. Metastases are more frequent in patients with pre-existing or concurrent thyroid pathology. In autopsy studies, the most common primary sites are breast carcinoma and lung carcinoma. Renal cell carcinoma, lung carcinoma and breast carcinoma predominate in clinical series. Upper aerodigestive tract primaries often directly infiltrate the thyroid gland. The underlying frequency of a histological subtype, geographic prevalence and aggressiveness of primary cancer likely contributes to the incidence of metastasis in the thyroid gland. This is seen in case series from Asia where gastric and oesophageal primary cancers predominate. Secondary thyroid cancer can present metachronously (60%), synchronously (34%), or as the first presentation of the underlying cancer (6%). Late metastases and first clinical presentations of disease often originate from renal cell carcinomas while synchronous cases tend to originate from the lungs. Other common primary sites for first presentation of secondary thyroid cancer include the lung and oesophagus. Although rare, secondary thyroid cancer should be considered as a differential particularly in patients with previous malignancy, such as from the kidney, lung, or breast.

Metastases to the Thyroid Gland: What Can We Do?

Metastases to the thyroid gland arise from other malignant tumors such as renal cell carcinoma, colorectal cancer, lung cancer, and breast cancer. In clinical practice, the incidence is low, and the symptoms are not specific, so it is often missed and misdiagnosed. It is finally diagnosed via the comprehensive application of many diagnostic methods, such as ultrasound, fine-needle aspiration biopsy, and immunohistochemistry analysis. Surgery-based comprehensive treatment is often adopted, but because it is usually in the late stage of the primary tumor, the prognosis is poor. In order to better understand the related characteristics of thyroid metastatic cancer and then improve the clinical diagnosis and treatment and the prognosis of patients, in this paper, we systematically summarize the research status of thyroid metastatic cancer.

Clinicopathological and Molecular Features of Secondary Cancer (Metastasis) to the Thyroid and Advances in Management

Secondary tumours to the thyroid gland are uncommon and often incidentally discovered on imaging. Symptomatic patients often present with a neck mass. Collision tumours of secondary tumours and primary thyroid neoplasms do occur. Ultrasound-guided fine-needle aspiration, core-needle biopsy, and surgical resection with histological and immunohistochemical analysis are employed to confirm diagnosis as well as for applying molecular studies to identify candidates for targeted therapy. Biopsy at the metastatic site can identify mutations (such as EGFR, K-Ras, VHL) and translocations (such as EML4-ALK fusion) important in planning target therapies. Patients with advanced-stage primary cancers, widespread dissemination, or unknown primary origin often have a poor prognosis. Those with isolated metastasis to the thyroid have better survival outcomes and are more likely to undergo thyroid resection. Systemic therapies, such as chemotherapy and hormonal therapy, are often used as adjuvant treatment post-operatively or in patients with disseminated disease. New targeted therapies, such as tyrosine kinase inhibitors and immune checkpoint inhibitors, have shown success in reported cases. A tailored treatment plan based on primary tumour features, overall cancer burden, and co-morbidities is imperative. To conclude, secondary cancer to the thyroid is uncommon, and awareness of the updates on diagnosis and management is needed.