Unusual metastases from differentiated thyroid cancers: A multicenter study in Korea

Yoon, Jee Hee; Jeon, Min Ji; Kim, Mijin; Hong, A Ram; Kim, Hee Kyung; Shin, Dong Yeob; Kim, Bo Hyun; Kim, Won; Shong, Young Kee; Kang, Ho‐Cheol

doi:10.1371/journal.pone.0238207

Cited by 23 publications

(32 citation statements)

References 36 publications

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“…Contrary to our report, only six patients of the latter group experienced lesions in more than one unusual metastatic site. Furthermore, most of these patients were diagnosed with PTC, and the median survival (68 months) was markedly inferior to the observed survival of our patient (more than 168 months) [ 13 ]. A meta-analysis by Paspala et al ., which included 11 patients with pancreatic metastases from thyroid carcinoma revealed an even worse median overall survival of only 37.6 months as opposed to the data presented in our report [ 22 ].…”

Section: Discussioncontrasting

confidence: 61%

“…In our patient, we observed metastases in different organs and soft tissue (that is, lung, heart, kidney, pancreas, and skeletal muscle) over a period of more than 14 years. Retrospective analyses have reported that 1–3% of all DTC display distant disease [ 13 , 18 ]. Although reports of patients experiencing more than three metastatic sites are scarce, Hugen et al .…”

Section: Discussionmentioning

confidence: 99%

“…reported on a cohort of 260 patients with metastasized DTC in which one-third of all patients displayed multisite metastases [ 25 ], confirming data reported by Yoon et al . [ 13 ]. Prognostic factors for favorable outcome were female gender, radiological detection of metastases without clinical symptoms, a long disease-free interval between primary diagnosis and metachronous metastases, and young age.…”

Section: Discussionmentioning

confidence: 99%

“…In general, FTC is known to metastasize less often than PTC. Metastatic lesions are mainly observed within the lungs, the bones, and the brain [ 12 , 13 ]. HCTC shows similar metastatic patterns, although some authors report a trend to more frequent distant lesions [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Hurthle cell thyroid carcinoma does not preclude long-term survival: a case report and review of the literature

et al. 2021

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Background Follicular thyroid carcinoma is the second most common malignancy of the thyroid gland. In 2016, the so-called Hurthle cell thyroid carcinoma, formerly known as the oxyphilic variant of the follicular thyroid carcinoma, was reclassified by the World Health Organization as a separate pathological entity, which accounts for approximately 3% of all thyroid cancers. Although Hurthle cell thyroid carcinomas are known for their more aggressive tumor biology, metastases are observed in a minority of cases, and long-term survival can be expected. However, disseminated disease is often associated with poor outcome. Case presentation In the presented case, a 63-year-old Caucasian female was incidentally diagnosed with Hurthle cell thyroid carcinoma after undergoing hemithyroidectomy for a nodular goiter. Following completion thyroidectomy, two courses of radioactive iodine therapy were administered. After 4 years of uneventful follow-up, the patient gradually developed metastases in five different organs, with the majority representing unusual sites, such as heart, kidney, and pancreas over a course of 14 years. The lesions were either treated with radioactive iodine therapy or removed surgically, depending on iodine avidity. Conclusion Follicular and Hurthle cell thyroid carcinoma are known to potentially spread hematogenously to typical sites, such as lung or bones, however; unusual metastatic sites as presented in our case can also be observed. A search of the literature revealed only scattered reports on patients with multiple metastases in unusual locations. Furthermore, the observed long-term survival of our patient is contradictory to the existing data. As demonstrated, recurrent disease may appear years after the initial diagnosis, emphasizing the importance of consistent aftercare. Radioactive iodine therapy, extracorporeal radiation therapy, and surgical metastasectomy are central therapeutic components. In summary, our case exemplifies that thorough aftercare and aggressive treatment enables long-term survival even in recurrent Hurthle cell thyroid carcinoma displaying unusual multisite metastases.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recurrent Hurthle cell thyroid carcinoma does not preclude long-term survival: a case report and review of the literature

et al. 2021

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“…Only sporadic reports are available on TA outcomes in liver metastases of other origins, including thyroid cancer. Use of LTA and RFA were described in single case-reports [90,91] as effective for rapid tumor burden decrease and associated with marked, but temporary, symptom improvement. Therefore, TA should be considered in a multimodality approach to DTC patients who are at surgical risk and in whom other treatment modalities are ineffective.…”

Section: Liver Metastasesmentioning

confidence: 99%

European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions

Mauri¹,

Hegedűs²,

Bandula³

et al. 2021

Eur Thyroid J

145

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The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.

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Cytopathology of the distant metastasis of papillary carcinoma of thyroid

Shastri

Kundu

Rohilla

et al. 2022

Diagnostic Cytopathology

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Aims To describe the cytomorphological features at distant metastatic sites apart from lymph nodes in papillary thyroid carcinoma (PTC). Materials and methods A total of eight cytology cases from seven patients reported as metastatic papillary carcinoma of thyroid were reviewed including available clinical and radiological details. The details clinical and cytological features were studied. Results There were a total of five males and two female patients. Two of these patients presented with lung nodules, two patients had bony lesion and lesion in kidney respectively and one patient had both bony and soft tissue lesions. Pleural fluid and bronchoalveolar lavage were received from remaining two patients. Cytology smears revealed papillary clusters and sheets of tumor cells, having round to oval nuclei with pale powdery chromatin, inconspicuous nucleoli and scant to moderate amount of cytoplasm. Nuclear features such as longitudinal nuclear grooves, intranuclear cytoplasmic inclusions were seen in all but one case. Nuclear enlargement and overlapping were variably present. Conclusions The diagnosis of metastatic PTC at uncommon locations is difficult. Since many of these locations are amenable to fine needle aspiration or exfoliative cytology evaluation, clinical awareness, and identification of classic cytomorphologic features can offer quick and accurate diagnoses. In cases with occult or unknown PTC presenting with metastases, cytomorphology may help in the prompt suggestion of detecting primary tumor in the thyroid.

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Unusual metastases from differentiated thyroid cancers: A multicenter study in Korea

Cited by 23 publications

References 36 publications

Recurrent Hurthle cell thyroid carcinoma does not preclude long-term survival: a case report and review of the literature

Recurrent Hurthle cell thyroid carcinoma does not preclude long-term survival: a case report and review of the literature

European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions

Cytopathology of the distant metastasis of papillary carcinoma of thyroid

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