Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology

Dural and calvarial metastasis of thyroid follicular carcinoma mimicking Sindou type 6 parafalcine meningioma

ABSTRACT

Fifty-two years, NID type-2 diabetic female was admitted with progressive headache, enlarging, pulsatile midline mass, dizziness, and numbness of extremities. Physical examination revealed only hypoesthesia in the upper left extremity C7-dermatome. Preoperative computed tomography revealed eroded parafalcian dural mass and caused a round 7 cm calvarial defect over the superior sagittal sinus (SSS) and another left parietal 1.2 cm satellite mass. Magnetic resonance imaging revealed an extra-axial, diffuse heterogeneous gadolinium-enhanced, well-circumscribed lesion invading the SSS and Trolard veins (bilaterally). Supratotal resection 1 cm from the tumor borders was performed, histopathology suggested papillary thyroid carcinoma follicular variant. The euthyroid patient underwent total thyroidectomy, and final pathology revealed invasive TFC. 5-year follow-up was uneventful without recurrence or new metastasis. Parafalcian meningioma classification was reviewed for the best surgical approach. The definitive diagnosis of meningioma should be established with histopathological analysis. TFC should be included in the differential diagnosis in cases of extra-axial tumors.

Case Report: A tortuous diagnosis and successful multimodal treatment of thyroid follicular carcinoma with pelvic metastasis

Purpose

To provide reference method for the treatment of thyroid follicular carcinoma by studing the clinical imaging, pathological features and multimodal treatment of a case of thyroid follicular carcinoma with bone metastasis.

Methods

By identifying the case's clinical, imaging, pathological features of a case of thyroid follicular carcinoma with bone metastasis, reflecting on the case's diagnosis and treatment process, and referring to literature about the characteristics of thyroid follicular carcinoma, the study aims to provide reference for the treatment of this kind of disease.

Result

A 67-year-old male patient was admitted to the hospital with clinical symptoms of left pelvic pain. The biopsy pathology showed well-differentiated thyroid tissue. Considering his medical history, conclusion of thyroid follicular carcinoma metastasis could be made.The patient was stable and no tumor progression was observed after a combination of therapies including ¹³¹I and topical and targeted agents.

Conclusions

Thyroid follicular carcinoma are prone to bone metastasis, and bone metastasis is the first symptom in some cases. Clinical imaging and pathology are needed for correct diagnosis, and a successful treatment requires a combination of multiple approaches including ¹³¹I, which is a Radioactive Iodine Therapy(RAI), local therapy and targeted drug therapy.

Cytodiagnosis of distant metastases from follicular thyroid carcinoma

INTRODUCTION

Follicular carcinoma of the thyroid is second most common primary malignancy of the thyroid gland after papillary carcinoma and metastasis is uncommonly seen in these patients.

AIMS AND OBJECTIVES

To describe the cytomorphologic features for the accurate diagnosis of distant metastases from follicular carcinoma of thyroid.

MATERIALS AND METHODS

A total of 10 aspirates reported as metastatic follicular carcinoma of thyroid were reviewed for the available clinical and radiological details.

RESULTS

All the patients were females. Six of these patients presented with subcutaneous and soft tissue swellings, one presented with a lung mass, one with right breast swelling, one with lumbar vertebral lesion and one with left iliac bone involvement. The cytology smears revealed tumour cells predominantly arranged in a repetitive microfollicular pattern with some scattered individually and in sheets. The tumour cells were small, had mild nuclear pleomorphism, round nuclei, low nuclear-cytoplasmic ratio, fine chromatin, inconspicuous nucleoli, and scanty to moderate amount of cytoplasm with some showing marginal vacuoles with "fire-flare" appearance. Occasional microfollicles showed scanty eosinophilic colloid in the center.

CONCLUSIONS

Identification and establishment of a correct clinical diagnosis of a distant metastasis from a follicular thyroid carcinoma is a challenging task. We believe that with prior knowledge of characteristic cytologic features, such metastases can be rapidly and accurately diagnosed by fine needle aspiration cytology.

Mesenchymal neoplasms of the kidney in adults: imaging spectrum with radiologic-pathologic correlation

Mesenchymal neoplasms of the kidney in adults cover a wide spectrum with characteristic ontogeny and histologic findings and variable biologic profiles and imaging findings. Benign mesenchymal renal tumors include angiomyolipoma, leiomyoma, hemangioma, lymphangioma, juxtaglomerular cell tumor, renomedullary interstitial cell tumor (medullary fibroma), lipoma, solitary fibrous tumor, and schwannoma. Malignant renal tumors of mesenchymal origin include leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, osteosarcoma, synovial sarcoma, fibrosarcoma, malignant fibrous histiocytoma, and solitary fibrous tumor. Cross-sectional imaging findings for mesenchymal renal tumors in adults are varied. Although angiomyolipomas and lipomas show macroscopic fat, lymphangiomas are cystic in appearance. Renal hemangioma may show phleboliths and a characteristic enhancement pattern. Leiomyoma typically arises from the capsule and causes buckling of the renal cortex. Although osteosarcoma may demonstrate characteristic dense ossification, most renal sarcomas demonstrate imaging features that are indistinguishable from the more common renal cell carcinoma. Although some renal mesenchymal tumors have typical imaging findings, biopsy is warranted to establish a definitive diagnosis. Awareness of the various mesenchymal renal tumors and familiarity with their imaging findings permit optimal patient management.

Unusual cutaneous metastatic follicular thyroid carcinoma

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer (TCs) after papillary carcinoma, but it is ranked first in producing distant metastases among TCs. It accounts for 10 – 20% of all thyroid malignancies and is most often seen in patients over 40 years of age. Distant metastases at the time of diagnosis are reported in 11 – 20% of the patients and may be the reason for presentation. There have been less than 30 reported cases of cutaneous metastases from FTC in the English Literature, a majority affecting the scalp. We present an unusual aggressive, hypervascular FTC in a 58-year-old man with a previous diagnosis of multinodular goiter. The difficulty in gaining his acceptability of orthodox management resulted in the development of multiple giant scalp and right facial metastatic masses associated with lytic calvarial destruction and the involvement of frontal and right maxillary sinuses. These imposed serious challenges in managing him in a resource-poor community.