J Korean Surg Soc.  2009 Jun;76(6):392-397. 10.4174/jkss.2009.76.6.392.

Metastasis to the Thyroid Gland in Patients with Metachronous Rectal Carcinoma and Adenocarcinoma of the Lungs

• Bong J
• Cho C
• Park S

• KMID: 1464957
• DOI: http://doi.org/10.4174/jkss.2009.76.6.392

Abstract

Metastasis to the thyroid gland is rare in clinical settings despite its rich vascular supply. A 60-year-old woman who had rectal cancer was diagnosed with thyroid malignancy with bilateral cervical lymph node metastases and primary adenocarcinoma of the left upper lung. We compared findings of H&E and various immunohistochemical stains including Thyroglobulin, CK7, CK20, CEA, TTF-1 of specimens of thyroid tumor, lung cancer and rectal cancer after total thyroidectomy. Thus, we achieved the final diagnosis of thyroid tumor as metastasis to the thyroid glands from primary adenocarcinoma of the lungs. In patients with a history of extra-thyroidal adenocarcinomas, we should consider metastasis to the thyroid gland. Immunohistochemical staining including thyroglobulin, CK7, CK20, CEA, TTF1 might be helpful to differentiate between primary thyroid carcinoma and metastasis from extra-thyroidal carcinoma to identify their origin.

Keyword

Metastases to thyroid; Adenocarcinoma of lung

MeSH Terms

Adenocarcinoma
Coloring Agents
Female
Humans
Lung
Lung Neoplasms
Lymph Nodes
Middle Aged
Neoplasm Metastasis
Rectal Neoplasms
Thyroglobulin
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Adenocarcinoma
Coloring Agents
Lung Neoplasms
Thyroglobulin

Figure

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  Fig. 1 Ultrasonographic findings of thyroid (A, B) and both internal jugular chain lymph node groups (C, D).

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  Fig. 2 Cytology finding of thyroid tumor obtained by fine needle aspiration. It was suggested to malignant thyroid tumor (Papanicolau, ×200).

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  Fig. 3 18F FDG PET-CT finding. That shows a modestly metabolic pulmonary lesion, LUL (green arrow, max SUV>4.27) and unusually increased thyroid FDG uptake: (blue arrow, max SUV>10.39).

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  Fig. 4 Histologic (A, H&E, ×100) and immunohistochemical findings of lung nodule obtained by CT-guided core needle biopsy. There show positive expressions for thyroid transcription factor-1 (B, ×100) and CK7 (C, ×40) immunohistochemical stains. The lung nodule was diagnosed to primary adenocarcinoma of lung.

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  Fig. 5 Gross (A), histologic (B, H&E, ×40) and immunohistochemical findings of thyroid gland tumor. There show negative expressions for thyroglobulin (C) and CK20 (D), but positive for thyroid transcription factor-1 (E) and CK7 (F) immunohistochemical stains (×100).

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