Endocrine Abstracts

Objective

To highlight the diagnostic difficulties that a pathologist may encounter in identifying intra-thyroid metastasis when the primary cancer is not known.

Case report

A 73-year-old woman with no specific pathological history, admitted for the management of a right mean spinal swelling that had appeared two months earlier and is gradually increasing in size. The evolution was marked by the association of dyspnea and discomfort to swallowing but without signs of thyroid dysfunction. On physical examination, the thyroid lodge was free. No neck nodes are palpable. Ultrasonography of the neck showed multiple jugular-carotid and sub-digastric right glands and thyroid nodule isthmic 8 mm. A lymph node biopsy concluded to a lymph node metastasis of partly papillary carcinoma compatible with thyroid origin. The Patient had a total thyroidectomy with a bilateral recurring and straight functional neck dissection with simple operating suites. The anatomopathological examination with immunohistochemistry concluded to a thyroid metastasis of a pulmonary-induced micropapillary carcinoma. Thoracic CT showed multiple parenchymal nodules and two focal areas of right basal pulmonary parenchymal condensation.A bronchial endoscopy with biopsy showed bronchial adenocarcinoma in its micropapillary variant. The patient received 3 chemotherapy cures based on cysplatyl and Vepeside with good evolution.

Conclusion

The frequency of intrathyroidal metastases are probably underestimated. The examination of the thyroid and a fine needle aspiration cytology at the slightest doubt represents a logical course of action. Thyroidectomy, when possible, improves patient survival. The prognosis depends on the primary lesion and the uni- or multi-visceral character of the metastasis.