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

Ultrasound Diagnosis Two Cases of Multiple Primary Malignancies Neoplasms: Thyroid Carcinoma, Breast Carcinoma, and Non-Hodgkin Lymphoma

Multiple primary malignant neoplasms (MPMNs) refer to the simultaneous or sequential presence of two or more malignant tumors in a single individual, with the clear exclusion of the possibility of metastasis between these tumors. The combination of thyroid carcinoma, breast carcinoma, and non-Hodgkin lymphoma is a rare manifestation of MPMNs, and accurate identification and diagnosis of these cases hold significant clinical importance. Due to its high resolution, affordability, and capability for superficial examination, ultrasound is often the preferred method for evaluating the thyroid, breast, and lymph nodes. Currently, ultrasound can provide accurate assessments of the nature of nodules in these areas through two-dimensional imaging combined with fine-needle aspiration biopsy. This study will present the ultrasound findings and the results of ultrasound-guided needle aspiration biopsies from two cases of MPMNs involving thyroid cancer, breast cancer, and non-Hodgkin lymphoma.

BRAF V600E-mutated lung adenocarcinoma with thyroid metastasis as the initial manifestation: a case report

Thyroid metastasis of lung adenocarcinoma is exceedingly uncommon. Here we present a case of a 72-year-old Chinese male with hoarseness, dysphagia, pain, and palpable thyroid nodules. Ultrasonography-guided thyroid fine-needle aspiration cytology (FNAC) suggested a high-grade follicular-derived thyroid carcinoma (HGFCTC). Molecular analysis identified a BRAF V600E mutation. Comprehensive histopathological and immunohistochemical examinations, however, revealed that the thyroid cancer originated from the left lung. The patient received a 6-month post-operative dual-target therapy with dalafenib and trametinib. As of the last follow-up, the patient was still alive, demonstrating the effectiveness of targeted therapy.

Ultrasonographic features and diagnostic accuracy of FNA and CNB in secondary thyroid malignancies: A retrospective study

Objective

This study aims to examine the ultrasonographic features of secondary thyroid malignancies and compare the diagnostic efficacy of fine-needle aspiration (FNA) and core needle biopsy (CNB) in this condition.

Methods

A retrospective analysis was conducted on 29 patients with secondary thyroid malignancies treated at our center between July 2011 and October 2022. Ultrasound images and clinical data were analyzed, and the lesions were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS).

Results

Among the 29 patients studied, primary tumor sites were predominantly the esophagus, lung, and nasopharynx. Comprehensive ultrasound data was available for 28 of these patients, revealing nodular lesions in 24 cases and diffuse lesions in 4 cases. Nodular lesions were predominantly solid or nearly solid hypoechoic nodules with parallel growth and extrathyroidal extension features, with a few showing macrocalcifications. Most patients had varying degrees of metastasis to neck lymph nodes. FNA accurately diagnosed 31.6 % of the lesions as secondary thyroid malignancies, while 5.3 % were misdiagnosed as papillary thyroid carcinoma (PTC). However, CNB demonstrated 100 % reliability in diagnosing secondary thyroid malignancies.

Conclusion

This study's categorization of secondary thyroid malignancy ultrasonographic features identifies nodular and diffuse patterns, with the application of ACR TI-RADS proving effective for nodular types. In detecting these lesions, CNB demonstrates superior sensitivity compared to FNA. Thus, in cases of thyroid lesions suspected to be malignant, particularly with enlarged neck lymph nodes and in patients with a history of malignancy, CNB is recommended as the diagnostic method of choice.

Fine-needle aspiration diagnosis of secondary malignant tumors of the thyroid gland: A single-institution experience of 17 cases

BACKGROUND

Fine-needle aspiration (FNA) is the most commonly used preoperative pathological diagnostic tool for thyroid tumors. Secondary malignant tumors of the thyroid gland account for less than 3% of all thyroid malignancies. The aim of this study was to investigate the types and cytopathological features of secondary thyroid tumors, evaluate diagnostic pitfalls in FNA.

METHODS

Cases of secondary thyroid tumors diagnosed in the Department of Pathology of Shaanxi Provincial People's Hospital were collected, and their clinical data, cytologic features, immunohistochemical results, and histopathological diagnoses were summarized.

RESULTS

The study included 17 cases (8 males and 9 females) with a mean age of 60.4 ± 9.4 years (range, 45-83 years). Six cases had a known history of primary malignancy prior to FNA aspiration diagnosis. The most common organs of origin were the lungs (5 cases, 3 adenocarcinoma, and 2 small-cell carcinoma) and esophagus (5 cases, 3 squamous-cell carcinoma, 1 adenocarcinoma, and 1 small-cell carcinoma). The next most common was squamous-cell carcinoma of the larynx (3 cases), and gastric tumor (2 cases), including 1 lymphoma and 1 adenocarcinoma. Cell blocks and immunohistochemistry were performed in 12 of these cases. Comparison of the impact of positive history and IHC availability on the accuracy of pathologic diagnosis showed that both were statistically significant.

CONCLUSION

FNA is an effective means of diagnosing secondary malignancies of the thyroid, in which knowledge of the patient's history of malignancy is essential, and the use of cell blocks and immunohistochemistry helps to clarify the pathological diagnosis.