Endocrine Abstracts

Follicular thyroid cancer is the second most common cause of thyroid carcinoma. Metastasis occurs in 10–15% of cases. Typical sites of metastasis include bone and lungs, scalp metastasis are rare, with <50 cases reported. We describe two such cases.

A retrospective chart review was performed on these patients, examining presentation, treatment and subsequent outcomes.

Patient 1. An abnormal lesion was noted on a routine chest X-ray, this was biopsied via bronchoscopy. Histology revealed follicular thyroid carcinoma and she proceeded to total thyroidectomy. This confirmed follicular thyroid cell carcinoma. Whole body iodine scanning showed activity in the salivary glands and lungs. She underwent iodine ablation therapy, but in the following months she noticed the development of a scalp lesion, resembling an ulcer. This was biopsied, revealing metastatic follicular thyroid cell carcinoma.

Patient 2 presented with back pain. As part of the diagnostic workup, she underwent an MRI spine, which revealed a metastatic deposit at the level of L2. This was biopsied which showed follicular thyroid tissue, consistent with metastatic disease. She underwent a total thyroidectomy. Following this, whole body iodine scanning revealed uptake in the thyroid bed, lungs and scalp. The scalp uptake was consistent with cutaneous metastasis and the scalp lesion resolved with radioactive iodine ablation therapy.

These cases describe the uncommon occurrence of scalp metastasis in patients with follicular thyroid carcinoma. Scalp metastasis are associated with poor prognosis. Of note both cases presented with advanced secondary disease, which is consistent with previous cases described in the literature.