Esophageal metastasis of hurthle cell thyroid carcinoma eight years after a subtotal thyroidectomy that mimicked esophageal hemangioma

An unusual case of hürthle cell carcinoma presenting as metastatic pleural disease 16 years after thyroidectomy

BACKGROUND

Hürthle cell carcinoma (HCC), a variant of a follicular carcinoma of the thyroid, is an aggressive type of differentiated thyroid cancer now considered a distinct pathologic entity. It may present as a low-grade tumor or as a more aggressive type. Prognosis depends on the age of the patient, tumor size, extent of invasion, and initial nodal or distant metastasis. Although thoracic involvement is not unusual with this tumor, this is the first report, to our knowledge, of latent pleural and lung metastases that were detected by a thoracentesis.

PATIENT AND METHODS

A 63-year-old woman underwent total thyroidectomy for a thyroid mass in 1990 that was diagnosed as HCC. In December 2006, she presented with symptoms of dyspnea and an abnormal chest x-ray. A subsequent ultrasound-guided thoracentesis revealed a malignant, exudative effusion. Cytopathologic analysis revealed the malignancy to be consistent with HCC. She was reevaluated by her original oncologist and is undergoing treatment for metastatic HCC.

CONCLUSIONS

Although rare, HCC may present years after definitive therapy as metastatic pleural and lung disease. Further studies are needed to determine the cause of latency in such cases.

Solitary spinal metastasis of Hürthle cell thyroid carcinoma

Hürthle cell carcinoma is a rare variant of differentiated thyroid cancer that occasionally forms distant metastases. However, even in the presence of metastases, patients with Hürthle cell carcinoma have a relatively good prognosis. There are few reports of Hürthle cell carcinoma metastases to the vertebral column, and none describing aggressive resection of spinal metastases. Here, we report a 68-year-old woman with a solitary metastasis of Hürthle cell carcinoma to the T1 vertebral body causing severe kyphotic deformity, myelopathy, and pain. The patient was treated with aggressive excisional decompression of the spinal cord and T1 vertebral body resection from an entirely posterior approach. Reconstruction and stabilization of the anterior spine was accomplished with a transforaminal lumbar interbody fusion allograft spacer and posterior instrumentation. We discuss aspects of the diagnosis, management, patient selection, and surgical treatment of metastatic Hürthle cell carcinoma in reference to the literature.