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Follicular Variant of Papillary Thyroid Cancer with Bilateral Renal Metastases Discovered Incidentally During Work-Up of Primary Endometrial Cancer: A Rare Occurrence.

Lubana SS, Singh N, Tuli SS, Bashir T, Sachmechi I, Kemeny MM - Am J Case Rep (2015)

Bottom Line: The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites.Immunohistochemistry plays an important role in determining the primary site of origin.In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.

ABSTRACT

Background: Follicular variant of papillary thyroid cancer (FV-PTC) is the second most common subtype of papillary thyroid cancer (PTC) after classic PTC. FV-PTC is characterized by nuclear features consistent with classic PTC but has a follicular architecture that lacks classic papillary morphology. Thyroid cancer rarely metastasizes to the kidney. Only 6 cases of FV-PTC metastasizing to the kidney have been reported in the English literature. We are reporting a case of FV-PTC with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer.

Case report: A 70-year-old woman presented with post-menopausal bleeding secondary to endometrial cancer. Staging work-up showed multiple bilateral lung nodules, bilateral soft tissue kidney masses, and multinodular goiter. The pathological and immnohistochemical profile of the lung biopsy was consistent with primary well-differentiated lung adenocarcinoma. Follow-up computerized tomography scan showed stable lung nodules and enlarging renal masses, which was suggestive of bilateral renal cancer. While the histologic features of the renal biopsy were not typical, the immunohistochemical staining of renal biopsy was positive for Paired box 8, thyroid transcription factor-1, thyroglobulin, and cytokeratin 7, suggesting the thyroid as the primary cancer site. The final histopathology on surgical specimen of total thyroidectomy revealed follicular variant of papillary thyroid cancer.

Conclusions: The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites. The clinician should be aware of the possibility of metastasis and look for the primary source, which in the present case was FV-PTC. Immunohistochemistry plays an important role in determining the primary site of origin. In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

No MeSH data available.


Related in: MedlinePlus

A total body iodine-131 scan demonstrates severe, widespread iodine avid metastatic disease seen in the thyroid lungs (red arrow), right (blue arrow) and left (yellow arrow) kidney, lungs (white arrow) and greater trochanter (green arrow).
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f13-amjcaserep-16-459: A total body iodine-131 scan demonstrates severe, widespread iodine avid metastatic disease seen in the thyroid lungs (red arrow), right (blue arrow) and left (yellow arrow) kidney, lungs (white arrow) and greater trochanter (green arrow).

Mentions: Thyroid ultrasound (US) showed a 5.0×2.4 cm nodule almost entirely occupying the right lobe and 2 nodules in the left lobe measuring 2.9×2.3 cm and 1.1×1.0 cm (Figure 11). Fine-needle aspiration biopsy of the thyroid revealed follicular neoplasm. The patient underwent total thyroidectomy in December of 2014. Histopathology of the surgical specimen revealed follicular variant of papillary thyroid cancer with clear cell differentiation and lymphovascular invasion (Figure 12). The regional lymph nodes were negative. Postoperatively, the patient was started on levothyroxine suppression therapy and received radioactive iodine ablation (200 mCi) in April 2015. An iodine-131 whole-body scan was performed, showing severe widespread disease in the lungs, liver, bilateral kidney (right more than left), and the right greater trochanter (Figure 13).


Follicular Variant of Papillary Thyroid Cancer with Bilateral Renal Metastases Discovered Incidentally During Work-Up of Primary Endometrial Cancer: A Rare Occurrence.

Lubana SS, Singh N, Tuli SS, Bashir T, Sachmechi I, Kemeny MM - Am J Case Rep (2015)

A total body iodine-131 scan demonstrates severe, widespread iodine avid metastatic disease seen in the thyroid lungs (red arrow), right (blue arrow) and left (yellow arrow) kidney, lungs (white arrow) and greater trochanter (green arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4509416&req=5

f13-amjcaserep-16-459: A total body iodine-131 scan demonstrates severe, widespread iodine avid metastatic disease seen in the thyroid lungs (red arrow), right (blue arrow) and left (yellow arrow) kidney, lungs (white arrow) and greater trochanter (green arrow).
Mentions: Thyroid ultrasound (US) showed a 5.0×2.4 cm nodule almost entirely occupying the right lobe and 2 nodules in the left lobe measuring 2.9×2.3 cm and 1.1×1.0 cm (Figure 11). Fine-needle aspiration biopsy of the thyroid revealed follicular neoplasm. The patient underwent total thyroidectomy in December of 2014. Histopathology of the surgical specimen revealed follicular variant of papillary thyroid cancer with clear cell differentiation and lymphovascular invasion (Figure 12). The regional lymph nodes were negative. Postoperatively, the patient was started on levothyroxine suppression therapy and received radioactive iodine ablation (200 mCi) in April 2015. An iodine-131 whole-body scan was performed, showing severe widespread disease in the lungs, liver, bilateral kidney (right more than left), and the right greater trochanter (Figure 13).

Bottom Line: The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites.Immunohistochemistry plays an important role in determining the primary site of origin.In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.

ABSTRACT

Background: Follicular variant of papillary thyroid cancer (FV-PTC) is the second most common subtype of papillary thyroid cancer (PTC) after classic PTC. FV-PTC is characterized by nuclear features consistent with classic PTC but has a follicular architecture that lacks classic papillary morphology. Thyroid cancer rarely metastasizes to the kidney. Only 6 cases of FV-PTC metastasizing to the kidney have been reported in the English literature. We are reporting a case of FV-PTC with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer.

Case report: A 70-year-old woman presented with post-menopausal bleeding secondary to endometrial cancer. Staging work-up showed multiple bilateral lung nodules, bilateral soft tissue kidney masses, and multinodular goiter. The pathological and immnohistochemical profile of the lung biopsy was consistent with primary well-differentiated lung adenocarcinoma. Follow-up computerized tomography scan showed stable lung nodules and enlarging renal masses, which was suggestive of bilateral renal cancer. While the histologic features of the renal biopsy were not typical, the immunohistochemical staining of renal biopsy was positive for Paired box 8, thyroid transcription factor-1, thyroglobulin, and cytokeratin 7, suggesting the thyroid as the primary cancer site. The final histopathology on surgical specimen of total thyroidectomy revealed follicular variant of papillary thyroid cancer.

Conclusions: The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites. The clinician should be aware of the possibility of metastasis and look for the primary source, which in the present case was FV-PTC. Immunohistochemistry plays an important role in determining the primary site of origin. In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

No MeSH data available.


Related in: MedlinePlus