Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature

Our plain-English summary of Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature, by P.A. Moghaddam, K.M. Cornejo, A. Khan (Endocrine Pathology, 2013).

The study

• Authors: P.A. Moghaddam, K.M. Cornejo, A. Khan
• Journal: Endocrine Pathology
• Published: 2013;24(3):116-24
• Type of article: Case report, Review
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The thyroid gland is an uncommon site for metastatic disease but cases have been well-documented in the literature, particularly in autopsy series. A retrospective review of surgical pathology and autopsy pathology database for patients with metastatic carcinoma to the thyroid was performed at the University of Massachusetts Medical Center between January 1993 to January 2013. We identified a total of 10 patients with metastatic carcinoma to the thyroid; 6 were in surgical pathology specimens out of a total of 1,295 thyroid carcinoma (0.46 %) and 4 were diagnosed at autopsy out of a total of 2,117 (0.19 %) autopsy cases during this period. Cases with direct extension of the tumor into the thyroid from local primary sites such as larynx, esophagus or soft tissues of the neck were excluded. The primary tumors in these cases comprised of four lung carcinomas, three colorectal carcinomas, a renal cell carcinoma, a pleural malignant mesothelioma, and an unknown primary. Therefore, it is important to keep intrathyroidal metastases in the differential diagnosis when evaluating a thyroid nodule, particularly in patients with a previous history of malignancy. Furthermore, a literature review reveals over 1,400 cases have been previously reported, with the most common malignancies from the kidney (34 %), lung (15 %), gastrointestinal tract (14 %), and breast (14 %).

In plain English

Pathologists at the University of Massachusetts Medical Center searched their surgical and autopsy records from January 1993 to January 2013 for cancers that had spread to the thyroid gland from elsewhere, and they also reviewed published reports. They found 10 patients: 6 among 1,295 surgical pathology thyroid cancer cases (0.46 %) and 4 among 2,117 autopsies (0.19 %). The case descriptions and table list the original cancers as four lung carcinomas, two colorectal carcinomas, and one each of breast carcinoma, renal cell carcinoma, malignant mesothelioma and unknown origin. The mesothelioma patient was a 69-year-old man who had undergone extrapleural pneumonectomy. His thyroid tumor stained in a pattern supporting metastatic malignant mesothelioma, and he had no evidence of disease at 11 months. The authors called this the third reported case of mesothelioma spreading to the thyroid. The article does not discuss asbestos. Their literature review counted 1,482 cases, most often from the kidney (34 %), lung (15 %), gastrointestinal tract (14 %) and breast (14 %). The authors concluded that metastatic disease should be considered when evaluating thyroid nodules, particularly in patients with prior cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of one institution's surgical and autopsy pathology files (case series of 10 patients), plus a review of the English-language literature
• Who was studied: 10 patients with cancer that had spread to the thyroid, identified at the University of Massachusetts Medical Center between January 1993 and January 2013 (4 at autopsy, 1 thyroidectomy, 3 lobectomies, 2 thyroid biopsies); patients whose tumor grew directly into the thyroid from nearby head and neck sites were excluded
• Exposure: No asbestos or other environmental or occupational exposure was studied or reported. The study concerns cancers from other organs spreading to the thyroid. One patient had malignant mesothelioma, but no exposure history is given.
• Main results:
  • Among surgical pathology specimens, 6 of 1,295 thyroid carcinoma cases (0.46 %) were metastases from other sites
  • Among autopsies, 4 of 2,117 cases (0.19 %) showed metastatic disease to the thyroid
  • Per the table and case reports, the primary cancers were four lung carcinomas, two colorectal carcinomas, and one each of breast carcinoma, renal cell carcinoma, malignant mesothelioma and unknown primary
  • A 69-year-old man with a history of malignant mesothelioma, treated by right-sided extrapleural pneumonectomy, had a thyroid mass about 1.5 years later. Lobectomy showed tumor cells positive for calretinin, WT1 and CK5/6, supporting metastatic malignant mesothelioma. The table records no evidence of disease at 11 months.
  • The authors described their mesothelioma case as the third reported case of metastatic mesothelioma to the thyroid, stating it occurs in 0.2 % of all metastatic intrathyroidal malignancies
  • The authors' literature review found 1,482 reported cases. The most common primary sites were kidney 509 (34 %), lung 222 (15 %), gastrointestinal 204 (14 %) and breast 202 (14 %).
  • Of 26 reported cases of cancer spreading into an existing thyroid tumor (tumor-to-tumor metastasis), 14 were malignant-to-benign and 12 were malignant-to-malignant
• The authors' conclusion: The authors concluded that metastatic disease to the thyroid is diagnostically challenging. They wrote that it is more common than expected, particularly in patients with a prior history of malignancy, and that thyroid nodules should be carefully evaluated to tell a primary thyroid cancer from a metastasis.
• Limitations the authors state:
  • The authors noted that one autopsy case had only a microscopic focus of tumor that could have been missed if the thyroid had not been adequately sampled

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Autopsy, Pathology, Malignant Mesothelioma, Differential Diagnosis.

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