[Intrathyroid metastases from kidney cancers: two case reports]

Solitary thyroid metastasis from colon cancer: a rare case report

Malignant metastases to the thyroid are rare and are even rarer from a colorectal primary. As these metastases are often asymptomatic, they are usually discovered incidentally on imaging performed as follow-up for the primary tumour. In this report, we present a case of metastatic sigmoid adenocarcinoma to the thyroid diagnosed and treated at our institution.

Thyroid metastasis of clear cell renal carcinoma: Report of a case

Renal cell carcinoma can recur many years after diagnosis and nephrectomy metastasizing even in uncommon sites, including thyroid gland. Thyroid metastases are extremely rare, the most frequent site of origin are renal tumors. Metastases in thyroid gland appear as painless nodules or masses, "cold" at scintiscan. We report the case of a 67-year-old male patient affected by clear cell renal carcinoma, diagnosed by fine-needle aspiration cytology procedures, and treated with anticancer medical therapy, who noticed after some months a mass in the neck-thyroid region requiring deeper medical investigations. By this way, thyroid fine-needle aspiration cytology reported a lesion made of malignant epithelial cells compatible with metastases of renal carcinoma (clear cell). Clinical and pathological data, together with immunostaining, supported the diagnosis of metastatic clear cell renal carcinoma. The diagnosis of metastatic disease, although difficult clinically and pathologically, should be suspected in patients with a clinical history of cancer, particularly in case of renal cell carcinoma, but fine-needle aspiration cytology can provide the clue for diagnosis.

[A locally advanced intrathyroid metastasis of bronchial cancer]

PURPOSE

To assess the characteristics, the diagnosis and the treatment of intrathyroid metastasis.

METHOD

The authors report a case of a locally advanced intrathyroid metastasis of a bronchial cancer.

RESULTS

A 60-year-old woman, treated seven years before for a well-differentiated bronchial adenocarcinoma, developed enlargement of the thyroid gland. Metastatic disease was confirmed by a surgical biopsy. Following incomplete radiochemotherapy, a palliative surgical debulking was performed, associating an isthmolobectomy with a large skin excision and closure with a pectoralis major myocutaneous flap.

CONCLUSION

Intrathyroid metastases are rare and usually treated by surgery. Surgical management is decided taking into account the type and the kinetics of the primary tumor, the location of the thyroid metastasis, and the extension of the metastatic disease. Except for isolated intrathyroid metastasis of kidney cancer, prognosis remains poor.

Métastases intrathyroïdiennes : série de 11 cas

INTRODUCTION

Non-thyroid cancers rarely metastasize into the thyroid gland. The aim of this retrospective study was to report a series of thyroid metastases and to emphasize their unusual occurrence and their poor prognosis.

METHODS

Between January 1987 and June 1999 eleven patients underwent thyroidectomy for isolated, metastatic diseases of non thyroidal origin (mean age 61 yrs, 54.5% female). The primary tumors were: pulmonary squamous cell carcinoma (n=5), renal cell carcinomas (n=2), esophageal squamous cell carcinoma (n=1), leiomyosarcoma (n=1), oropharynx squamous cell carcinoma (n=1), and breast carcinoma (n=1). Analyzing these cases, there is a marked preponderance of lung cancers, renal cancer coming second in order of frequency. Clinical manifestations are: thyroid nodule without hormonal disturbance; others signs are dysphonia and/or dysphagia.

RESULTS

Ten patients underwent preoperative fine-needle aspiration, nine of ten were suggestive of metastatic disease. The mean time from resection of the primary tumor to thyroid metastases was 25 months (range 1-96 months). Total thyroidectomy (n=9) or lobectomy (n=2) was performed without morbidity or mortality. No patients have had recurrent disease in the neck. Median survival after treatment was 10 months (range 1-29 months). Course of death were mainly disseminated metastases.

CONCLUSION

For isolated metastatic cancer to the thyroid, surgical resection should be performed in order to avoid potential morbidity of tumor recurrence in the neck, even if the prognosis remains poor, for the majority of the cases.

Les métastases intrathyroïdiennes du cancer du rein à cellules claires : présentation de sept cas et revue de la littérature

PURPOSE

The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma.

PATIENTS AND METHODS

Seven patients were retrospectively collected from files of different Burgundy's hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist.

RESULTS

Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence.

CONCLUSIONS

Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.