Lung adenocarcinoma with thyroid metastasis: a case report

Abstract

BackgroundThe metastases of a primary lung cancer over the thyroid gland are extremely rare. We report on an unusual presentation of thyroid metastasis of lung cancer in order to improve the management of similar cases.Case presentationThree years ago, a Moroccan male 59-year-old was admitted for dyspnea, dry cough, and chest pain. He had smoked about 30 cigarette packs a year. Clinical examination revealed a right thyroid nodule. Chest and neck computed tomography (CT) scan showed a proximal left tumor in contact with the pulmonary artery and revealed a suspected nodule in the right lobe of the thyroid with homolateral neck node. Transbronchial biopsy was performed and pathological examination revealed adenocarcinoma of the lung and positive for thyroid transcription factor. Other explorations carried out, such as brain CT, bone scan and abdominal ultrasound were normal. After a repeated negative fine needle aspiration biopsy of the suspected nodule of the right lobe of the thyroid, we performed total thyroidectomy with neck dissection. An anatomopathologic exam revealed a tubulopapillary adenocarcinoma poorly differentiated. An Immunohistochemistry showed positive tumor cells with TTF1 and cytokeratin (CK) 7 but negative cells with thyroglobulin and CK20. Thus, the pulmonary tumor was classified stage IV. Chemotherapy based on the combination of cisplatin and etoposide was conducted along with supportive care. The tumor grew up with brain metastases after three cycles of chemotherapy. Unfortunately, the patient died 2 months after despite brain radiotherapy.ConclusionWe presented a medical case of a patient with thyroid metastasis resulting from a pulmonary adenocarcinoma which has rapidly evolved to brain metastases. The prognosis was pejorative in our clinical case (5 months after admission).

An Unusual Case of Metastatic Non-Small Cell Lung Cancer Misidentified as Anaplastic Thyroid Cancer

“…11,12) Additionally, immunohistochemistry can be used to distinguish between metastases and primary thyroid tumors. 13 Fig. 3).…”

Thyroid primary and metastatic malignant tumours of poor prognosis may mimic subacute thyroiditis - time to change the diagnostic criteria: case reports and a review of the literature

“…Rapidly growing primary thyroid carcinomas, including mainly very poorly prognostic anaplastic cancer, are characterized by a fulminant course of the disease, and delayed diagnosis - even a week or two - can dramatically reduce the patient’s life expectancy and deteriorate life quality. Thyroid metastases can also grow rapidly, stretching the capsule, and infiltrate surrounding tissues, which result in the same neck pain [11–17]. Thyroid abscess is difficult to distinguish from SAT [7] and one should remember that thyroid abscess is a very rare condition which may be the result of infection of decaying necrotic tissues in anaplastic thyroid cancer, as it occurred in Patient No.…”

“…Dao et al [17] recently reported a 59-year old man with lung adenocarcinoma and very fast diagnosis of thyroid metastasis, despite diagnostic difficulties. In this case, repeated FNAB of the suspected thyroid nodule were negative and total thyroidectomy with neck dissection was performed allowing finally to confirm diagnosis of lung cancer metastasis [17]. The diagnostic difficulties in this case are similar to our Patient No.…”

A Rare Case of Thyroid Metastasis Secondary to Hidden Undiagnosed Lung Adenocarcinoma

“…Furthermore, lung cancer incidence is rising with adenocarcinoma leading the race with 38.5% of all lung cancers followed by squamous cell carcinoma and large cell carcinoma [ 5 , 6 ]. However, metastasis to thyroid secondary to lung lesion is considered an uncommon incident with few studies reporting it in the literature [ 7 - 9 ].…”