Complete diaphysis resorption of the femur: A case report in a metastatic papillary thyroid cancer

Abstract

Introduction Although differentiated thyroid cancers generally have a good prognosis, a small proportion of patients will have recurrent or progressive disease. Bone resorption due to thyroid cancer can cause significant challenges in the clinical management and rehabilitation. Presented case Nearly total femur resorption was found as a first presentation in a patient with thyroid cancer. The patient complained about chronic pain in her left thigh that had progressed into an inability to walk. She was treated by a traditional healer for six years before she was persuaded by a social worker to seek medical help. X-rays showed pathological loss of the right diaphyseal femur. Neck CT-scan showed a left thyroid mass with tracheal deviation, with multiple lytic lesions in the sternum and 5th rib. Needle biopsy of the thyroid mass resulted in an inconclusive follicular neoplasm. Total thyroidectomy and neck dissection revealed a classical type of papillary thyroid carcinoma. After thyroid ablation, she opted for palliative radiotherapy and bisphosphonate treatment for the bone metastases. Discussion Bone metastases are rarely detected at the time of thyroid cancer diagnosis. In the presence of bone metastasis, median survival of well-differentiated thyroid cancer decreases into only 4 years. Bone metastases are often neglected and less studied than regional lymph node and lung metastases. Conclusion Although well differentiated thyroid cancer is usually indolent, a neglected bone metastasis at an initial diagnosis might adversely affect patient's quality of life and prognosis.

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

“…A papillary thyroid malignancy was post-operatively confirmed. The patient further underwent 131 I radioiodine therapy (200 mCi), local radiotherapy, and monthly zoledronate therapy for bone involvement [ 33 ].…”

Fracture Neck of the Femur: A Case of Two Pathologies

“…For instance, DLBCL of the mandibular bone was incidentally found to be associated with papillary thyroid carcinoma in a case report [ 24 ]. Suwardjo et al reported the presence of papillary thyroid cancer with NOF fracture [ 25 ]. Evans et al reported a case of primary thyroid lymphoma with bone marrow infiltration at presentation [ 26 ].…”

Hemi-mandibulectomy without bony reconstruction: A case report of mandibular metastasis from a silent differentiated papillary thyroid cancer

“…Papillary thyroid carcinoma has been considered as indolent cancer with lower propensity to metastasize to distant organs. In circumstances of delayed diagnosis or inadequate initial detection and treatment, however, we have reported some cases of papillary thyroid cancer with large bone resorption [ 10 ] and gross extrathyroidal extension [ 11 ]. Several factors including large tumor size, lymphovascular invasion, and certain aggressive variants are associated with distant metastases [ 2 , 12 ].…”