Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer

Abstract

Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.

Response of canine thyroid carcinomas to radioiodine

“…In people, ectopic thyroid tissue has been reported in the abdomen, however to date, there are no reports to date of ectopic thyroid carcinoma within the abdomen 38,39 . However, abdominal metastasis to the adrenal glands, liver, stomach, pancreas and kidneys have been reported in people with thyroid carcinoma 40–43 . In many cases, lesions are amenable to 131 I treatment, however in the presented case there was no radiotracer uptake on scintigraphy, and progression occurred following 131 I.…”

“…38,39 However, abdominal metastasis to the adrenal glands, liver, stomach, pancreas and kidneys have been reported in people with thyroid carcinoma. [40][41][42][43] In many cases, lesions are amenable to 131 I treatment, however in the presented case there was no radiotracer uptake on scintigraphy, and progression occurred following 131 I. In people, responses to 131 I are reported to be less effective in non-99m Tc-pertechnetate avid metastasis, thus this treatment modality is not strongly recommended in canine patients with nonfunctional thyroid tumours that lack radiotracer uptake.…”

Distinguishing between metastatic and benign adrenal masses in patients with extra-adrenal malignancies

“…However, the large number of visits for thyroid diseases in our hospital may cause a certain selection bias. Differentiated thyroid carcinoma rarely metastasizes ( 14 ). Thyroid carcinoma accounted for only 0.8% of the primary lesions in patients with AM in this study.…”

Collision tumor of a thyroid papillary and follicular carcinoma: A case report

“…The rst case of a collision tumor of PTC and FTC was reported by Plauche et al in 2013 [2]. Since then, 16 cases of collision tumors of PTC and FTC including our case have been reported in the English literature [2][3][4][5][6][7][8][9][10][11]. The reported series of collision tumors of PTC and FTC are summerised in Table 2.…”

“…PTC is the most common accounting for 75-80% of cases, and FTC is the second most common accounting for about 10% of all thyroid cancers [1].However, a collision tumor of PTC and FTC is extremely rare. To the best of our knowledge, only fteen cases have been published in the English literature [2][3][4][5][6][7][8][9][10][11]. The present case was a report of a collision tumor of PTC and FTC, which exhibited different histology, phenotype and genetic alterations in the tumor tissue.…”