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Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology.

Lee MW, Batoroev YK, Odashiro AN, Nguyen GK - Cytojournal (2007)

Bottom Line: Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer.In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody.All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada. mwlee@cha.ab.ca

ABSTRACT
Three men and 2 women with ages ranging from 37 to 70 years, clinically and histologically confirmed solitary, palpable metastatic cancers to the thyroid (SMCT) and preoperative cytologic investigation of their thyroid lesions by fine-needle aspiration (FNA), were reviewed. Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer. Direct smears prepared from the patients' thyroid FNAs were fixed in 95% ethanol and stained with the Papanicolaou method. In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody. A correct cytodiagnosis of metastatic cancer to the thyroid was made in all 5 cases. In 1 patient the thyroid FNA revealed a metastatic RCC that led to the discovery of a clinically occult RCC. All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

No MeSH data available.


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The thyroid needle aspirate in patient 4 shows single and loosely clustered polygonal cells with abundant, granular cytoplasm and eccentrically located oval nuclei with prominent nucleoli, suggesting a Hurthle cell carcinoma versus a metastatic amelanotic melanoma (Papanicolaou stain, × 400).
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Figure 5: The thyroid needle aspirate in patient 4 shows single and loosely clustered polygonal cells with abundant, granular cytoplasm and eccentrically located oval nuclei with prominent nucleoli, suggesting a Hurthle cell carcinoma versus a metastatic amelanotic melanoma (Papanicolaou stain, × 400).

Mentions: In all five cases, the thyroid needle aspirates revealed abundant malignant cells admixed with a small number of benign follicular epithelial cells. Sheets of non-keratinizing malignant squamous cells admixed with isolated keratinizing malignant squamous cells were present in the thyroid needle aspirate of patient 1, indicating a moderately differentiated squamous cell carcinoma (Figure 1). The thyroid tumor in this patient was most likely a metastatic neoplasm, as the cytologic finding in his thyroid FNA was similar to that of the needle aspirate of his previously resected bronchogenic squamous cell carcinoma. Patient 2 showed in her thyroid FNA small malignant cells with scant cytoplasm and small, oval hyperchromatic nuclei wrapping around round basophilic globules, characteristic for a metastatic adenoid cystic carcinoma. A few round basophilic bodies were also present (Figures 2 and 3). The cytologic findings in this patient were similar to those of the needle aspirate from her previously resected parotid adenoid cystic carcinoma. In patient 3 with a previously resected renal cell carcinoma (RCC), the thyroid FNA revealed irregular large, monolayered sheets of malignant epithelial cells with granular and clear cytoplasm, suggesting a metastatic RCC, clear cell type (Figure 4). However, a thyroid Hurthle cell carcinoma was not ruled out with certainty. The tumor cells in this patient stained negatively with thyroglobulin antibody and further confirmed that the patient's lesion was a metastatic RCC. Patient 4 who had a previously resected scalp melanoma yielded in his thyroid FNA revealed several single and loosely clustered malignant large polygonal cells with oval nuclei, conspicuous nucleoli and abundant, granular cytoplasm without intracytoplasmic melanin pigment granules, suggesting a metastatic amelanotic melanoma (Figure 5). However, a Hurthle cell or anaplastic carcinoma of the thyroid was not ruled out with confidence on cytologic basis alone. Two cellular smears from this patient were stained with thyroglobulin and HMB-45 antibodies. The tumor cell cytoplasm reacted negatively with thyroglobulin and positively with HMB-45 antibodies (Figure 6). The immunocytochemical results in this case indicated a metastatic amelanotic melanoma to the thyroid. In patient 5, the thyroid FNA revealed large, monolayered sheets of malignant epithelial cells with granular or clear cytoplasm that were similar to those of patient 2, and a metastatic RCC, clear cell type to her thyroid was suggested. However, neither a Hurthle cell tumor nor a carcinoma of the thyroid with clear cell change was not ruled out. A Papanicolaou-stained cellular smear from this patient was stained with thyroglobulin antibody. The tumor cell cytoplasm reacted negatively with this antibody, suggesting a metastatic RCC, clear cell type. Further clinical and diagnostic imaging studies in patient 5 revealed a 7-cm tumor in her right kidney that was subsequently proven to be a clear cell RCC by histologic examination of her resected renal kidney.


Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology.

Lee MW, Batoroev YK, Odashiro AN, Nguyen GK - Cytojournal (2007)

The thyroid needle aspirate in patient 4 shows single and loosely clustered polygonal cells with abundant, granular cytoplasm and eccentrically located oval nuclei with prominent nucleoli, suggesting a Hurthle cell carcinoma versus a metastatic amelanotic melanoma (Papanicolaou stain, × 400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1808473&req=5

Figure 5: The thyroid needle aspirate in patient 4 shows single and loosely clustered polygonal cells with abundant, granular cytoplasm and eccentrically located oval nuclei with prominent nucleoli, suggesting a Hurthle cell carcinoma versus a metastatic amelanotic melanoma (Papanicolaou stain, × 400).
Mentions: In all five cases, the thyroid needle aspirates revealed abundant malignant cells admixed with a small number of benign follicular epithelial cells. Sheets of non-keratinizing malignant squamous cells admixed with isolated keratinizing malignant squamous cells were present in the thyroid needle aspirate of patient 1, indicating a moderately differentiated squamous cell carcinoma (Figure 1). The thyroid tumor in this patient was most likely a metastatic neoplasm, as the cytologic finding in his thyroid FNA was similar to that of the needle aspirate of his previously resected bronchogenic squamous cell carcinoma. Patient 2 showed in her thyroid FNA small malignant cells with scant cytoplasm and small, oval hyperchromatic nuclei wrapping around round basophilic globules, characteristic for a metastatic adenoid cystic carcinoma. A few round basophilic bodies were also present (Figures 2 and 3). The cytologic findings in this patient were similar to those of the needle aspirate from her previously resected parotid adenoid cystic carcinoma. In patient 3 with a previously resected renal cell carcinoma (RCC), the thyroid FNA revealed irregular large, monolayered sheets of malignant epithelial cells with granular and clear cytoplasm, suggesting a metastatic RCC, clear cell type (Figure 4). However, a thyroid Hurthle cell carcinoma was not ruled out with certainty. The tumor cells in this patient stained negatively with thyroglobulin antibody and further confirmed that the patient's lesion was a metastatic RCC. Patient 4 who had a previously resected scalp melanoma yielded in his thyroid FNA revealed several single and loosely clustered malignant large polygonal cells with oval nuclei, conspicuous nucleoli and abundant, granular cytoplasm without intracytoplasmic melanin pigment granules, suggesting a metastatic amelanotic melanoma (Figure 5). However, a Hurthle cell or anaplastic carcinoma of the thyroid was not ruled out with confidence on cytologic basis alone. Two cellular smears from this patient were stained with thyroglobulin and HMB-45 antibodies. The tumor cell cytoplasm reacted negatively with thyroglobulin and positively with HMB-45 antibodies (Figure 6). The immunocytochemical results in this case indicated a metastatic amelanotic melanoma to the thyroid. In patient 5, the thyroid FNA revealed large, monolayered sheets of malignant epithelial cells with granular or clear cytoplasm that were similar to those of patient 2, and a metastatic RCC, clear cell type to her thyroid was suggested. However, neither a Hurthle cell tumor nor a carcinoma of the thyroid with clear cell change was not ruled out. A Papanicolaou-stained cellular smear from this patient was stained with thyroglobulin antibody. The tumor cell cytoplasm reacted negatively with this antibody, suggesting a metastatic RCC, clear cell type. Further clinical and diagnostic imaging studies in patient 5 revealed a 7-cm tumor in her right kidney that was subsequently proven to be a clear cell RCC by histologic examination of her resected renal kidney.

Bottom Line: Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer.In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody.All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada. mwlee@cha.ab.ca

ABSTRACT
Three men and 2 women with ages ranging from 37 to 70 years, clinically and histologically confirmed solitary, palpable metastatic cancers to the thyroid (SMCT) and preoperative cytologic investigation of their thyroid lesions by fine-needle aspiration (FNA), were reviewed. Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer. Direct smears prepared from the patients' thyroid FNAs were fixed in 95% ethanol and stained with the Papanicolaou method. In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody. A correct cytodiagnosis of metastatic cancer to the thyroid was made in all 5 cases. In 1 patient the thyroid FNA revealed a metastatic RCC that led to the discovery of a clinically occult RCC. All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

No MeSH data available.


Related in: MedlinePlus