A CASE OF PAPILLARY CARCINOMA THYROID WITH HEMATOGENOUS SPREAD

AND RARE SOFT TISSUE METASTASES

Prof Dr.S.Saradha M.S., Dr.R.Radhika M.S.,

Dr.P.Murugadasan M.S., Dr.Sujith M.Jose M.S Post Graduate

Coimbatore Medical College

Introduction• Papillary Carcinoma is the

most common thyroid malignancy.

• Metastases typically disseminate via lymphatic spread to regional lymph nodes.

• Distant metastases are present at diagnosis in 3-5% of cases.

Case Report

65 year old male admitted with neck swelling of 5 years duration and swelling over Left cheek of 3 months duration.

• He had history of fracture distal femur after a trivial trauma 6 months back

X Ray shows pathological fracture Femur Distal end with callus formation

• Cough of 1 month duration

• Hemoptysis of 1 week duration

History of loss of weight and appetite of 6 months duration

On Examination

• Patient was moderately built and nourished.• Patient was anemic.• No palpable cervical lymphnodes• A swelling of size 8*6*4 cm was present in front of neck

which moves up with deglutition. – Surface bossalated– Dilated veins over the swelling– Firm to hard in consistency– Lower border palpable– Carotid pulsations present on either sides

• Another swelling of size 4*3*3cm was present over the left cheek.

• Mobility of the swelling got restricted on clenching teeth

Investigations

• Basic blood investigations done• Thyroid profile done – Euthyroid state• USG Neck –

• Diffuse swelling of Thyroid gland• Right lobe- 7*6*4.5cm• Left lobe- 8*6.6*5cm• Areas of calcification ++

• FNAC from the Thyroid swelling showed thyroid follicular cells arranged in syncytial clusters and microfollicles, features suggestive of follicular neoplasm

• FNAC from the Left maxillary swelling showed small round cells arranged in microfollicles, features suggestive of metastatic carcinomatous deposits from follicular carcinoma of thyroid.

• CT showed features of malignant mass from thyroid with multiple pulmonary, skeletal and brain metastases.

• Tumor partly encasing the common carotid artery• The soft tissue mass on the left side of cheek,

infilterating the masseteric muscle

Course and Treatment

• After adequate preoperative preparation,we proceeded with total thyroidectomy as a debulking procedure.

• Gland was deeply adherent to the trachea,and tracheostomy was done during the procedure

• Specimen was send for Histopathological Examination

• Retrospectively, histopathology report of the thyroid specimen came to be PAPILLARY CARCINOMA THYROID

(Papillary Carcinoma with focal Cribriform Morular Pattern and Squamous morules without keratinisation)

• Post operatively, patient was on ventilatory support.

• Patient was weaned from ventilator and is in followup with Radioactive Iodine Ablation Therapy and

• External Beam Radiotherapy for Brain and Femur Metastasis

Discussion

• Papillary Carcinoma is the most common thyroid malignancy (80% of Thyroid malignancy)

• Lymph node metastases are common• Distant metastases are uncommon,

develop in upto 20% patients• Most common sites are

Lungs > Bones > Liver > Brain

• The most important risk factor for papillary cancer is childhood radiation exposure

• Other important risk factors:– history of thyroid cancer in a first-degree

relative– presence of a familial syndrome that includes

thyroid cancer, such as Werner syndrome, Carney complex, and familial polyposis.

• Thyroid neoplasm may form well-defined follicles, with only minimal papillary architecture. They are classified as the follicular variant of papillary carcinoma and constitutes about 10% of papillary cancers.

• Histologically Pure follicular variant and Mixed pattern of follicular and papillary structures are classified as papillary carcinoma because they behave pathologically as papillary carcinoma thyroid

The case reported herein is interesting because,

Extrathyroidal extension into the soft tissue can occur, but distant soft tissue and skeletal muscle metastases are rarely reported in literature

Thyroid malignancy with hematogenous spread need not always be follicular carcinoma

thank you