J Korean Soc Endocrinol.  2006 Feb;21(1):85-89. 10.3803/jkes.2006.21.1.85.

A Case of Papillary Thyroid Carcinoma Combined with Metastatic Renal Cell Carcinoma in the Thyroid

• Cheon KI
• Lee KW
• Mok JO
• Kim YJ
• Park HK
• Kim CH
• Kim SJ
• Byun DW
• Suh KI
• Yoo MH
• Kim HK
• Ko YW

• KMID: 2200679
• DOI: http://doi.org/10.3803/jkes.2006.21.1.85

Abstract

Metastasis to the thyroid from distant cancer is rarely diagnosed clinically and renal cell carcinoma is the most common group of neoplasm to metastasize to the thyroid. Papillary thyroid carcinoma is known as the most frequent primary thyroid cancer. But coexistence with metastatic renal cell carcinoma to thyroid and papillary thyroid carcinoma is very rare. We are reporting this highly unusual case of metastatic renal cell carcinoma to thyroid, which harbored papillary thyroid cancer. To our knowledge, this is the first case reported in Korea. A 57-year-old woman presented with hoarseness and palpable anterior neck mass. She had a history of renal cell carcinoma of right kidney, which had been resected 10 years previously and had undergone lower anterior resection due to sigmoid colon cancer 2 months before. Fine needle aspiration cytology suggested follicular neoplasm, and total thyroidectomy was performed. The pathology from the thyroid nodules showed papillary thyroid cancer combined metastatic renal cell carcinoma.

MeSH Terms

Biopsy, Fine-Needle
Carcinoma, Renal Cell*
Female
Hoarseness
Humans
Kidney
Korea
Middle Aged
Neck
Neoplasm Metastasis
Pathology
Sigmoid Neoplasms
Thyroid Gland*
Thyroid Neoplasms*
Thyroid Nodule
Thyroidectomy

Figure

• 

  Fig. 1 Neck CT with contrast enhancement shows multiple solid nodules in both thyroid gland and diffuse goiter.

• 

  Fig. 2 Gross appearance of the right thyroid gland. Several well-demarcated ovoid masses are noted, ranging from 0.4 × 0.4 to 1.2 × 1.0 cm. The cut surface is bright yellow and reddish brown.

• 

  Fig. 3 (A) The white and fibrotic area in the left thyroid gland is composed of numerous true papilla with complex branching (H & E stain, × 40). (B) The tumor cells have optically clear nuclei and pseudoinclusions (arrow) (H & E stain, × 200).

• 

  Fig. 4 The tumor cells have abundant clear cytoplasm and round nuclei and arranged in an alveolar structure by delicate vascular septa (H & E stain, × 400).

• 

  Fig. 5 The normal thyroid tissue is positive for thyroglobulin (arrow) while the metastatic renal cell carcinoma is negative (IHC, × 100).

Reference

1. Shimaoka K, Sokal JE, Pickren JW. Metastatic neoplasms in the thyroid gland: pathologic and clinical findings. Cancer. 1962. 15:557–565.

2. Silverberg SG, Vidone RA. Metastatic tumors in the thyroid. Pac Med Surg. 1966. 74:175–180.

3. Abrams HL, Spiro R, Goldstein N. Metastasis in carcinoma: analysis of 1,000 autopsied cases. Cancer. 1950. 3:74–85.

4. Wychulis AR, Beahrs OH, Woolner LB. Metastasis of carcinoma to the thyroid gland. Ann Surg. 1964. 160:169–177.

5. Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatic disease to the thyroid gland. World J Surg. 1999. 23:177–180.

6. Ivy HK. Cancer metastatic to the thyroid: a diagnostic problem. Mayo Clin Proc. 1984. 59:856–859.

7. McCabe DP, Farrar WB, Petkov TM, Finkelmeier W, O'Dwyer P, James A. Clinical and pathologic correlations in disease metastatic to the thyroid gland. Am J Surg. 1985. 150:519–523.

8. Kihara M, Yokomise H, Yamauchi A. Metastasis of renal cell carcinoma to the thyroid gland 19 years after nephrectomy: a case report. Auris Nasus Larynx. 2004. 31:95–100.

9. Pitale SU, Sizemore GW, Bakhos R, Dejong SA, Flanigan RC, Emanuele NV. Renal cell carcinoma with metastasis to the thyroid gland. Urol Oncol. 2000. 5:173–175.

10. Dekernion JB, Ramming KP, Smith RB. The natural history of metastatic renal cell carcinoma: a computer analysis. J Urol. 1978. 120:148–152.

12. Kim TY, Kim WB, Gong GU, Hong SJ, Shong YK. Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy. Clin Endocrinol. 2005. 62:236–241.

13. Kim E, Mattar AG. Primary and secondary carcinoma with focal nodular hyperplasia in a multinodular thyroid: case report. J Nucl Med. 1976. 17:983–984.

14. Willis RA. Metastatic tumors in the thyroid gland. Am J Pathol. 1931. 197:187–208.

15. Linton RR, Barney JD, Moorman HD, Lerman J. Metastatic hypernephroma of the thyroid gland. Surg Gynecol Obstet. 1946. 83:493–498.

16. Smith SA, Gharib H, Goellner JR. Fine needle aspiration. Usefulness for diagnosis and management of metastatic carcinoma to the thyroid. Arch Intern Med. 1987. 147:311–312.

17. Czech JM, Lichtor TR, Carney JA, van Heerden JA. Neoplasms metastatic to the thyroid gland. Surg Gynecol Obstet. 1982. 155:503–505.

18. Nakhjavani MK, Gharib JR, Goellner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer. 1997. 79:574–578.

19. Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK. 18-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patient: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope. 2005. 115:1074–1078.

20. Kierney PC, van Heerden JA, Segura JW, Weaver AL. Surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy; an institutional review. Ann Surg Oncol. 1994. 1:345–352.

21. Congiu A, Nicolosi A, Malloci A, Piga A, Calo PG, Murtas MG. Isolated thyroid and skin metastasis of renal carcinoma. Minerva Chir. 1995. 49:223–227.

22. Schroder S, Bocker W. Clear-cell carcinomas of thyroid gland: a clinicopathological study of 13 cases. Histopathology. 1986. 10:75–89.

23. Amo-Takyi BK, Handt S, Gunawan B, Hollweg HG, Fuzesi L. A cytogenetic approach to the differential diagnosis of metastatic clear cell renal carcinoma. Histopathology. 1998. 32:436–443.