Metastatic thyroid carcinoma presenting as malignant pleural effusion: A cytologic review of 5 cases

Vyas, Monika; Harigopal, Malini

doi:10.1002/dc.23547

Cited by 9 publications

(27 citation statements)

References 15 publications

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“…Thyroid cancers, the most common malignant tumors of endocrine organs, are frequently found in the papillary subtypes but rarely metastasize to the pleura. The incidence is reported to be <0.1% of malignant pleural effusions . Anaplastic transformation is a rare evolution of this disease.…”

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confidence: 99%

Anaplastic thyroid carcinoma mimicking a malignant pleural mesothelioma: Clues for diagnosis

Capron¹,

Giusiano

Bourinet

et al. 2019

Thoracic Cancer

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Pleural metastasis of thyroid carcinoma is very rarely encountered in the evaluation of pleural effusion and diagnosis may be challenging. However, an anaplastic transformation of papillary thyroid carcinoma (PTC), although a rare condition, should be considered even after a prolonged period of patient follow‐up. Here we report a case of anaplastic thyroid carcinoma mimicking malignant pleural mesothelioma diagnosed nine years after the initial diagnosis of PTC and detail the clues used to orient and confirm the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Anaplastic thyroid carcinoma mimicking a malignant pleural mesothelioma: Clues for diagnosis

Capron¹,

Giusiano

Bourinet

et al. 2019

Thoracic Cancer

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“…[2][3][4][5] Other less commonly reported primary thyroid tumors include anaplastic thyroid carcinoma, poorly differentiated carcinoma, and Hurthle cell carcinoma. The main primary sites are lung, breast, ovary, gastrointestinal (GI) tract and pancreas.…”

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“…The main primary sites are lung, breast, ovary, gastrointestinal (GI) tract and pancreas. 3,4 Among thyroid malignancies, papillary thyroid carcinoma is the most frequently described in the literature. 2 Thyroid carcinoma only rarely metastasizes to the serous cavities with an incidence of <0.1%.…”

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confidence: 99%

“…[1][2][3] In addition to adenocarcinoma, almost any malignant tumor can be the underlying cause of an effusion, including hematopoietic malignancies, squamous cell carcinoma, and melanoma, among others. [2][3][4][5] Other less commonly reported primary thyroid tumors include anaplastic thyroid carcinoma, poorly differentiated carcinoma, and Hurthle cell carcinoma. 3,4 Among thyroid malignancies, papillary thyroid carcinoma is the most frequently described in the literature.…”

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Cytological features of medullary thyroid carcinoma in ascitic effusion

Rosa

2017

Diagnostic Cytopathology

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ascitic fluid, cytology, medullary thyroid carcinoma Malignant serous effusions are often encountered in cytopathology.The most common secondary malignancy leading to body cavity effusions is adenocarcinoma. The main primary sites are lung, breast, ovary, gastrointestinal (GI) tract and pancreas. 1-3 In addition to adenocarcinoma, almost any malignant tumor can be the underlying cause of an effusion, including hematopoietic malignancies, squamous cell carcinoma, and melanoma, among others. 2 Thyroid carcinoma only rarely metastasizes to the serous cavities with an incidence of <0.1%. 3,4 Among thyroid malignancies, papillary thyroid carcinoma is the most frequently described in the literature. [2][3][4][5] Other less commonly reported primary thyroid tumors include anaplastic thyroid carcinoma, poorly differentiated carcinoma, and Hurthle cell carcinoma. 4,6 Reportedly, metastases from thyroid primaries are more frequent to the pleural cavities. 7 Herein, a case of medullary thyroid carcinoma metastatic to the peritoneal cavity is described. To our knowledge, medullary thyroid carcinoma in ascitic fluid has not been described before.A 38 year-old woman was evaluated at our institution due to abdominal pain secondary to ascites. The patient had a history of dysplastic nevi syndrome and medullary thyroid carcinoma (MTC) diagnosed at an outside institution 3 years prior. During the 3 years following her thyroid surgery, she continued to progress requiring neck revision for persistent nodal disease, as well as developing pulmonary and liver nodules which were not biopsied.The patient did not have features of multiple endocrine neoplasia syndrome II (MEN II) and was RET proto-oncogene germline mutation negative. A paracentesis was performed. Over 1000 cc of yellow fluid was sent for cytological analysis, from which 2 cytospins and 1 cell-block were prepared. The cytospins were very cellular and were composed predominantly of mixed inflammation, numerous macrophages and some identifiable mesothelial cells. There were a few tridimensional cell clusters that stood out from the benign/inflammatory background ( Figure 1A). The clusters were composed of mild to moderately pleomorphic cells with occasional nuclear membrane irregularities and an inconspicuous nucleolus displaying significant nuclear molding. Nuclear size was comparable or only slightly larger than the nuclear size of the background macrophages. The cytoplasm was moderate in amount and the clusters displayed community borders ( Figure 1B). Occasional acinar formations were appreciated in the cell-block ( Figure 1C). In addition to exploring the possibility of metastasis from her known MTC and due to the exceedingly rare occurrence of thyroid primaries metastasizing to the peritoneal cavities, immunostains (IHC) were performed for confirmation. The cells of interest were positive for TTF-1, MOC-31, chromogranin and calcitonin and negative for WT-1, PAX-8 and calretinin ( Figure 1D). The diagnosis of metastatic MTC was rendered. Serological levels of calcitonin ...

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Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases

Mustafa

Malenie

Mir³

et al. 2022

Cancer Cytopathology

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Background: Malignant effusions secondary to thyroid carcinomas are rare, and publications on this topic are limited. This study presents a large cohort of thyroid carcinomas involving effusion cytology. Methods: A 20-year computerized search for fluid cytology diagnosed with thyroid malignancy was performed. The following data were collected: patients' demographics, clinical findings, and histologic diagnoses. The cytology slides and ancillary tests were reviewed. Results: Among 47,593 specimens, 15 thyroid carcinomas involving the pleural fluid from 11 patients were found. There were six males and five females with a mean age of 72 years. Ten patients with available follow-up died of their disease. Papillary thyroid carcinoma (PTC) was the only histologic type. Ten cytology cases were available for review. The cytologic findings common to all cases were nonspecific (clusters/three-dimensional architecture, enlarged irregular nuclei, and scant to abundant to vacuolated cytoplasm). The classic PTC features were not present in all cases (fine/powdery chromatin [80%], micronucleoli [70%], nuclear grooves [50%], papillary-like architecture [40%], psammoma bodies [40%], and pseudo-nuclear inclusions [20%; present on the cell block only]). In 11 of the 15 cases, the diagnosis was rendered with immunohistochemical stains performed on the cell block (paired box 8, thyroid transcription factor 1, and thyroglobulin). In four of the 15 cases, the cytologic diagnosis was made after a comparison with prior surgical pathology or fluid cytology. Conclusions: PTC is the most common histologic type of thyroid malignancy involving pleural effusion. Because the cytologic findings are nonspecific and classic PTC features are not always present, the clinical history in conjunction with immunohistochemical stains is helpful in arriving at the correct diagnosis.

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Metastatic thyroid carcinoma presenting as malignant pleural effusion: A cytologic review of 5 cases

Cited by 9 publications

References 15 publications

Anaplastic thyroid carcinoma mimicking a malignant pleural mesothelioma: Clues for diagnosis

Anaplastic thyroid carcinoma mimicking a malignant pleural mesothelioma: Clues for diagnosis

Cytological features of medullary thyroid carcinoma in ascitic effusion

Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases

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