A 80+ year old male presents with a nodule on the right anterior neck, present for two years and growing. The patient reported a history of right thyroidectomy in 2010 and review of systems was otherwise negative. Exam showed a 1 cm, mobile, non-tender nodule. A biopsy was performed and histology is below.
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DIAGNOSIS & CASE SUMMARY:
Metastatic thyroid cancer, follicular type. The histopathologic findings in the biopsy from the nodule show a tumor composed of closely packed glandular structures with central pink (colloid) secretion. The cells lining the glandular structures are cuboidal with dark-staining round nuclei with inconspicuous nucleoli. These glandular structures are actually thyroid follicles. To some degree, the morphology is practically indistinguishable from normal thyroid and is thus classified as the follicular type (recapitulates normal thyroid follicles) thyroid carcinoma.
On further investigation the patient did recall having been given a diagnosis of thyroid cancer at the time of his thyroidectomy years prior, but was unsure of type or stage. He did not have any further treatment at that time. We assisted the patient in getting an appointment with his prior oncologist and recommended that he return to us for follow up. He has not returned to the clinic as recommended.
ABOUT THIS DIAGNOSIS:
Although thyroid carcinoma is the most common endocrine malignancy, cutaneous metastases are rare. Papillary thyroid carcinoma is the most common type to metastasize to the skin (41%) of cases with follicular type (as seen here) composing 28% of cases. On rare occasions, cutaneous disease can be the initial presentation of thyroid carcinomas. Outcomes and prognosis for thyroid carcinoma with metastasis are generally poor. However, nearly half of patients with metastasis are alive at a median follow-up of 5.5 years, regardless of whether they were diagnosed with metastatic disease on initial presentation or whether they developed metastasis after initial thyroid surgery.
Alwaheeb S, Ghazarian D, Boerner SL, et al Cutaneous manifestations of thyroid cancer: a report of four cases and review of the literature. Journal of Clinical Pathology 2004;57:435-438