Metastatic renal cell carcinoma to the thyroid gland 24 years after the primary tumour

Abstract

SUMMARYAmong the metastases to thyroid gland, metastases from renal cell carcinoma (RCC) are not rare and their frequent macroscopic looks are similar to primary thyroid tumours. We report an unusual case of thyroid metastases from renal carcinoma in a 72 -year-old man presented with a 1-year history of choking spells, stridor and dyspnoea. Patient underwent right nephrectomy for RCC, 24 years ago. In the present case, a right hemithyroidectomy was performed for a suspected anaplastic thyroid carcinoma. Histological examination showed a metastases of a clear cell renal carcinoma. Although the RCC showed an indolent biological behaviour, the late thyroid metastases have concurred with a poor prognosis and the patient died 5 months after surgery. The interest of this case lies in the long progression-free survival of the RCC preceded by the diagnosis of the thyroid nodule and the discrepancy between the clinical-radiological and the histological assessment. BACKGROUND

Metastatic renal cell carcinoma in the thyroid gland: ultrasonographic features and the diagnostic role of core needle biopsy

“…Clinically significant inaccurate FNA rates specific to metastatic RCC have been further observed in other studies and case reports, with inaccuracy rates ranging up to 82.3% [6,9,14,15,20-22]. The majority of nondiagnostic FNA results were reported as benign or indeterminate [6,14,20-22]. On the other hand, CNB was able to accurately diagnose metastatic RCC without further investigation in most cases [15,23].…”

“…In comparison, FNA showed high accuracy when used to diagnose other common metastatic malignancies, such as breast cancer (94.7%) and lung cancer (90.1%) [2]. Clinically significant inaccurate FNA rates specific to metastatic RCC have been further observed in other studies and case reports, with inaccuracy rates ranging up to 82.3% [6,9,14,15,20-22]. The majority of nondiagnostic FNA results were reported as benign or indeterminate [6,14,20-22].…”

Metastases to the Thyroid: Potential Cytologic Mimics of Primary Thyroid Neoplasms

“…3,4,11 The majority of these metastases are not synchronous, with rare cases being reported up to 24 years after the primary lesion diagnosis. 12,13 Clinically evident SIT can present as a palpable mass (more than 70% of patients), vocal cord palsy, or thyroid dysfunction. On the other hand, a small subset of patients can be asymptomatic and show an incidentally detected thyroid lesion on imaging studies.…”

Secondary or Second Primary Malignancy in the Thyroid? Metastatic Tumors Suggested Clinically: A Differential Diagnostic Task

“…In the scientific literature, many cases of metastatic tumors in the thyroid have been published as case reports describing the pitfalls of individual case diagnosis supported by a literature overview, stressing the specific context of the more frequent primary malignancies or the reporting a rare malignancy metastasizing to the thyroid [11,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. Meta-analyses are available for the most frequent primary malignancies [32,33].…”

“…The available meta-analyses share sites of the most common primary malignancies, with these clearly being cell kidney carcinoma, breast carcinoma, and lung carcinoma [10]. The history of previous neoplastic disease treatments may be missing and the disease-free interval is long [7,11]. The wide spectrum of thyroid primary malignancies and their histo-/cyto-/pathological variants can interfere with the diagnosis [12].…”