J Korean Soc Radiol.  2014 Jun;70(6):403-407. 10.3348/jksr.2014.70.6.403.

Sonographic and CT Features of Follicular Thyroid Carcinoma with Interrupted Eggshell Calcification Presenting with Renal and Bony Metastases: A Case Report

• Lee SK
• Kwon SY
• Kim SH
• Rho BH

• KMID: 1941765
• DOI: http://doi.org/10.3348/jksr.2014.70.6.403

Abstract

We report a case of follicular thyroid carcinoma (FTC) in a 74-year-old man, with interrupted eggshell calcification presenting with renal and bony metastases. The abdominal and chest CT showed three homogeneously enhancing masses in the right kidney, second lumbar vertebra, and left fourth rib. The neck CT revealed a mass with interrupted eggshell calcification and homogeneous enhancement in the left thyroid lobe. A thyroid mass with interrupted eggshell calcification and its peripheral and central vascularity had excellent demonstration on sonography. The pathologic findings of the specimens of the thyroid mass, obtained by sonographically guided fine-needle aspiration biopsy, and the renal mass, obtained by sonographically guided core-needle biopsy, were consistent with follicular neoplasm and metastatic follicular carcinoma, respectively. The interrupted eggshell calcification of FTC in the elderly patients may frequently be associated with the distant metastasis. Thus, this may potentially represent a poor prognostic sign rather than a favorable one.

MeSH Terms

Adenocarcinoma, Follicular*
Aged
Biopsy
Biopsy, Fine-Needle
Calcinosis
Humans
Kidney
Neck
Neoplasm Metastasis*
Ribs
Spine
Thyroid Gland
Tomography, X-Ray Computed
Ultrasonography*

Figure

• 

  Fig. 1 CT and sonographic features of follicular thyroid carcinoma with interrupted eggshell calcification and metastatic lesions of the kidney and bones in a 74-year-old man. A, B. Contrast-enhanced axial CT image of the abdomen (A) shows an exophytically grown, homogeneously enhancing mass at the lower pole of the right kidney (arrows) and a homogeneously enhancing mass with bony destruction at the body and right pedicle of the second lumbar vertebra (arrowheads). A contrast-enhanced axial CT image of the chest (B) shows a homogeneously enhancing mass with bony destruction at the left fourth rib (arrows). C, D. A non-enhanced axial CT image of the neck (C) reveals a mass with eggshell calcification (arrowheads) that has an area of interruption (arrow). Contrast-enhanced coronal reformatted CT image (D) shows homogeneous enhancement of the mass (asterisk), and eggshell calcification (arrowheads) that has areas of interruption (arrows). E, F. Transverse gray-scale sonographic image of the thyroid gland (E) shows an ovoid, solid mass with eggshell calcification (arrowheads) that has areas of interruption (arrows) in the lower pole of the left thyroid lobe. Transverse power Doppler sonography (F) reveals color signals within (asterisks) and around the mass (arrowheads). G, H. Photomicrograph of the cytological examination of the specimen obtained by sonographically guided fine-needle aspiration biopsy of the left thyroid mass with interrupted eggshell calcification (G) demonstrates sheets of atypical follicular cells (arrowheads) and scanty colloid (asterisks). Follicular cells are arranged to form microfollicles (arrows) (Papanicolaou stain, × 400). Photomicrograph of the histological examination of the specimen obtained by sonographically guided core-needle biopsy of the right renal mass (H) shows numerous, variable sized follicles filled with colloid (asterisks) (hematoxylin & eosin stain, × 100). Tumor cells show mild cytologic atypia (arrowheads) and form microfollicles (arrows) (inset: hematoxylin & eosin stain, × 400).

Reference

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