Cutaneous metastases from a papillary thyroid carcinoma

Cytomorphological spectrum of scalp lesions in the population of a developing country: A retrospective study

BACKGROUND

Scalp lesions are frequently encountered in clinical practice. Fine-needle aspiration cytology (FNAC) can characterize most of these lesions; however, there is little published work on cytology of scalp lesions.

METHODS

Records of all the patients subjected to FNAC from January 2011 to August 2016 were retrieved from the archives of the Cytopathology section of our Institute. Out of the 71 852 cases reviewed, 896 patients, who presented with palpable scalp lesions, were included in the study. Aspirates were obtained with a 23-gauge needle attached to a 10 mL disposable plastic syringe. May-Grünwald-Giemsa stained and Pap stained slides were prepared. Special stains and immunocytochemical analysis were done when necessary.

RESULTS

Out of the 896 cases of aspirates from scalp lesions, 155 (17.2%) aspirates were found to be inadequate for diagnosis. One hundred and fifty-seven (21%) out of 741 adequate aspirates showed features of inflammatory or reactive pathology comprising of abscesses (57), cystic lesions (24), tubercular lesions (16), and reactive lymphadenopathy (66). Four hundred and fifteen (56%) aspirates revealed a tumor-like etiology comprising of epidermal cyst (395), sebaceous cyst (4), dermoid cyst (1), calcinosis (7), vascular malformation (7), hematoma (5), and juvenile xanthogranulomatous lesion (1). Tumorous lesions formed 22.3% of the aspirates. Of these, 7 cases (4.2%) were of metastases to the scalp.

CONCLUSION

In a developing country, FNAC is a useful and cost-effective investigation for the diagnosis of a wide spectrum of scalp lesions. It allows rapid diagnosis and permits timely intervention thereby preventing complications due to delay in diagnosis.

Metastatic papillary thyroid carcinoma to the nose: report and review of cutaneous metastases of papillary thyroid cancer

Background:

Metastatic papillary thyroid carcinoma typically appears in local lymph nodes. Skin metastases are rare.

Purpose:

A man with progressive metastatic papillary thyroid carcinoma who developed a cutaneous metastasis on his nose is described. The clinical manifestations of metastatic papillary thyroid carcinoma to skin are reviewed.

Methods:

PubMed was used to search the following terms, separately and in combination: basal, cancer, carcinoma, cell, cutaneous, kinase, inhibitor, metastases, nose, papillary, rearranged during transfection, receptor, RET, thyroid, tyrosine, vandetanib.

Results:

Pathologic changes observed on the biopsy of the man’s nose lesion were similar to those of his original cancer. Genomic evaluation of the tumor revealed an aberration involving the rearranged during transfection (RET) receptor tyrosine kinase. The residual tumor was excised. Treatment with vandetanib, a RET inhibitor was initiated; his metastatic disease has been stable, without symptoms or recurrent cutaneous metastasis, for 2 years following the discovery of his metastatic nose tumor.

Conclusions:

Papillary thyroid carcinoma with skin metastases is rare. Nodules usually appear on the scalp or neck; the thyroidectomy scar is also a common site. Metastatic tumor, albeit infrequently, can present as a nose lesion. The prognosis for patients with cutaneous metastases from papillary thyroid carcinoma is poor. However, with the ability to test the tumor for genomic aberrations, molecular targeted therapies—such as tyrosine kinase inhibitors—may provide extended survival in these individuals.

?Metastatic papillary carcinoma of the thyroid

BACKGROUND

Cutaneous metastases from thyroid carcinomas, although uncommon, have been previously reported and are usually found in association with evidence of disseminated disease.

METHODS

We report a 75-year-old male who presented with a 4-cm reddish violaceous nodule on the left temple and a clinical history significant for papillary carcinoma of the thyroid.

RESULTS

Microscopic examination of a 4-mm punch biopsy revealed a poorly circumscribed neoplasm with focal epidermal connection and multiple cystic cavities and papillary projections.

CONCLUSIONS

This case report describes a solitary cutaneous lesion as the first evidence of disseminated neoplastic disease in a patient with no other clinical evidence of concurrent metastases. The histology of the lesion was unusual in that it mimicked a primary cutaneous neoplasm.

Carcinoma erysipeloides associated with anaplastic thyroid carcinoma

Cutaneous metastases from carcinoma of the thyroid gland are rare and carcinoma erysipeloides is even rarer. We present the clinical, histological, and immunohistochemical features of inflammatory erysipeloid metastases arising from an anaplastic carcinoma of the thyroid gland. In this case the anaplastic carcinoma probably transformed from a pre-existing, long-standing papillary carcinoma of the thyroid gland. Although visible inflammation is a hallmark of many benign skin disorders, it is not commonly present in cutaneous malignant metastases. As a result, the significance of a marked inflammatory changes in association with metastatic skin disease may not be recognized. Dermatologists need to be aware of the potential for inflammatory manifestations in cutaneous metastases from a thyroid carcinoma.

Papillary and follicular thyroid carcinoma metastatic to the skin: a case report and review of the literature

Cutaneous metastases from thyroid cancers are rare. We report the case of an otherwise asymptomatic 81-year-old woman with an enlarging scalp lesion. Her solitary skin metastasis was the presenting feature of thyroid carcinoma. Routine histopathology of the lesion was notable for an atypical clear cell neoplasm. Immunohistochemistry was positive for thyroglobulin. Subsequent resection of the thyroid gland identified separate foci (< 1 cm) for both papillary and follicular carcinoma. Although such immunohistochemical staining has been used previously, it has never been reported to provide the definitive diagnosis for a solitary cutaneous metastasis from the thyroid. Previous tumors had anatomic features in a clinical context that permitted identification by routine light microscopy. Clear cell features found in the follicular focus of carcinoma in the thyroid suggest that it is the primary. A worldwide literature review reveals that follicular carcinoma has a greater preponderance than papillary carcinoma for cutaneous metastasis and that the majority of skin metastases from either papillary or follicular thyroid cancer are localized to the head and neck.