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Metastasis of colon cancer to medullary thyroid carcinoma: a case report.

Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, Kim CH, Kang SK, Mok JO - J. Korean Med. Sci. (2014)

Bottom Line: He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery.Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC).To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

ABSTRACT
Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.

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Histopathologic and immunohistochemical staining findings of thyroid lesion. (A) Gross findings reveal a well circumscribed round gray-tan nodular mass with an ill defined white solid portion and central irregular yellow necrosis (arrow). (B) Microscopic findings show a medullary carcinoma which is composed of nests or sheets of round or spindle tumor cells and acellular eosinophilic stroma (center), and colonic adenocarcinoma with glandular differentiation (right) in the normal thyroid parenchyme (left), (H&E stain, ×40). (C) Immunohistochemical staining for chromogranin A reveals positive staining in medullary carcinoma (brown) and negative staining in colonic adenocarcinoma (×40). (D) Immunohistochemical staining for calcitonin shows diffuse strong cytoplasmic positivity (brown) in the tumor cell of medullary component (×100). (E) Immunohistochemical staining for CDX2 shows a strong positive nuclear staining (brown) in colonic adenocarcinoma (×200).
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Figure 2: Histopathologic and immunohistochemical staining findings of thyroid lesion. (A) Gross findings reveal a well circumscribed round gray-tan nodular mass with an ill defined white solid portion and central irregular yellow necrosis (arrow). (B) Microscopic findings show a medullary carcinoma which is composed of nests or sheets of round or spindle tumor cells and acellular eosinophilic stroma (center), and colonic adenocarcinoma with glandular differentiation (right) in the normal thyroid parenchyme (left), (H&E stain, ×40). (C) Immunohistochemical staining for chromogranin A reveals positive staining in medullary carcinoma (brown) and negative staining in colonic adenocarcinoma (×40). (D) Immunohistochemical staining for calcitonin shows diffuse strong cytoplasmic positivity (brown) in the tumor cell of medullary component (×100). (E) Immunohistochemical staining for CDX2 shows a strong positive nuclear staining (brown) in colonic adenocarcinoma (×200).

Mentions: On gross examination, the capsule of the right lobe of thyroid was intact, smooth, and the surface was irregularly bosselated. The cut sections revealed a well-circumscribed, round gray-tan nodular mass, measuring 1.5×1.2 cm. There is an ill defined white solid mass with central irregular yellow necrosis, measuring 0.8×0.7 cm in the gray-tan nodular mass (Fig. 2A). Histological examination revealed metastatic colonic adenocarcinoma in MTC (Fig. 2). An immunohistochemical stain of CEA and caudal type homeobox protein CDX-2 showed a strong, diffuse positivity in colonic adenocarcinoma. In contrast, the medullary thyroid cancer cells were positive for chromogranin-A and calcitonin and negative for the colonic adenocarcinoma marker. Results of immunohistochemical stain of tumor cells are described in Table 1. There was no regional lymph node metastasis.


Metastasis of colon cancer to medullary thyroid carcinoma: a case report.

Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, Kim CH, Kang SK, Mok JO - J. Korean Med. Sci. (2014)

Histopathologic and immunohistochemical staining findings of thyroid lesion. (A) Gross findings reveal a well circumscribed round gray-tan nodular mass with an ill defined white solid portion and central irregular yellow necrosis (arrow). (B) Microscopic findings show a medullary carcinoma which is composed of nests or sheets of round or spindle tumor cells and acellular eosinophilic stroma (center), and colonic adenocarcinoma with glandular differentiation (right) in the normal thyroid parenchyme (left), (H&E stain, ×40). (C) Immunohistochemical staining for chromogranin A reveals positive staining in medullary carcinoma (brown) and negative staining in colonic adenocarcinoma (×40). (D) Immunohistochemical staining for calcitonin shows diffuse strong cytoplasmic positivity (brown) in the tumor cell of medullary component (×100). (E) Immunohistochemical staining for CDX2 shows a strong positive nuclear staining (brown) in colonic adenocarcinoma (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214946&req=5

Figure 2: Histopathologic and immunohistochemical staining findings of thyroid lesion. (A) Gross findings reveal a well circumscribed round gray-tan nodular mass with an ill defined white solid portion and central irregular yellow necrosis (arrow). (B) Microscopic findings show a medullary carcinoma which is composed of nests or sheets of round or spindle tumor cells and acellular eosinophilic stroma (center), and colonic adenocarcinoma with glandular differentiation (right) in the normal thyroid parenchyme (left), (H&E stain, ×40). (C) Immunohistochemical staining for chromogranin A reveals positive staining in medullary carcinoma (brown) and negative staining in colonic adenocarcinoma (×40). (D) Immunohistochemical staining for calcitonin shows diffuse strong cytoplasmic positivity (brown) in the tumor cell of medullary component (×100). (E) Immunohistochemical staining for CDX2 shows a strong positive nuclear staining (brown) in colonic adenocarcinoma (×200).
Mentions: On gross examination, the capsule of the right lobe of thyroid was intact, smooth, and the surface was irregularly bosselated. The cut sections revealed a well-circumscribed, round gray-tan nodular mass, measuring 1.5×1.2 cm. There is an ill defined white solid mass with central irregular yellow necrosis, measuring 0.8×0.7 cm in the gray-tan nodular mass (Fig. 2A). Histological examination revealed metastatic colonic adenocarcinoma in MTC (Fig. 2). An immunohistochemical stain of CEA and caudal type homeobox protein CDX-2 showed a strong, diffuse positivity in colonic adenocarcinoma. In contrast, the medullary thyroid cancer cells were positive for chromogranin-A and calcitonin and negative for the colonic adenocarcinoma marker. Results of immunohistochemical stain of tumor cells are described in Table 1. There was no regional lymph node metastasis.

Bottom Line: He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery.Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC).To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea.

ABSTRACT
Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.

Show MeSH
Related in: MedlinePlus