J Korean Soc Radiol.  2016 Apr;74(4):267-272. 10.3348/jksr.2016.74.4.267.

Two Breast Metastases from Thyroid Carcinoma Presented 6 Years Later after Total Thyroidectomy: A Case Report

• Kwon GH
• Kang BJ
• Jung NY
• Kim SH
• Lee A

• KMID: 2208786
• DOI: http://doi.org/10.3348/jksr.2016.74.4.267

Abstract

Thyroid carcinoma is usually indolent with good prognosis, as compared to other malignancy. Distant metastases from thyroid cancer are rare and usually manifest as multiple lesions especially in lungs, bones and lymph nodes, in advanced stages of the disease. Metastasis to the breast from thyroid carcinoma is extremely rare, with about 16 cases reported in the English literature. Herein, we reported a case of metastatic poorly differentiated thyroid carcinoma, which presented as 2 breast masses in a 72-year-old woman, 6 years after total thyroidectomy for papillary thyroid carcinoma. Although the computed tomography (CT) and ultrasonography (USG) image findings are nonspecific oval mass with circumscribed or partially indistinct margin, metastases from thyroid cancer should be included in the differential diagnosis when recurrence of thyroid carcinoma is suspected. Also, fusion images of CT and USG are helpful to the radiologists in localizing the targeted lesion and conducting accurate USG-guided biopsy.

MeSH Terms

Aged
Biopsy
Breast*
Diagnosis, Differential
Female
Humans
Lung
Lymph Nodes
Neoplasm Metastasis*
Positron-Emission Tomography
Prognosis
Recurrence
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy*
Ultrasonography

Figure

• 

  Fig. 1 Imaging findings of metastatic tumors in the right breast from thyroid carcinoma in a 72-year-old woman, 6 years after initial thyroidectomy. A-C. Periareolar lesion in the 3 o'clock direction (long thin white arrows; upper column) and another peripheral lesion in the 8 o'clock direction (short thick white arrows; lower column) of the right breast are shown in the positron emission tomography/computed tomography (PET/CT), chest CT, ultrasonography (USG), and CT navigated USG fusion images. 18F-fluorodeoxyglucose (FDG) uptake in 2 nodular lesions on axial image of PET/CT (A) is noted in the inner portion and outer lower portion of the right breast. The lesions are soft tissue attenuated and homogenously enhanced after contrast injection on axial image of chest CT scan (B). On CT navigated USG fusion images (C), the periareolar lesion is oval, circumscribed, non-parallel oriented mass with hypo- to isoechogenicity, surrounded by premammary fat. The other lesion is visualized as oval, partially indistinct marginated and hypoechoic mass with parallel orientation. CT navigated USG fusion image reaffirms that prior FDG-avid nodules are matched to the hypoechoic masses on sonogram, surrounded by fat.

• 

  Fig. 2 Pathologic findings of metastatic tumors in the right breast from thyroid carcinoma in a 72-year-old woman, 6 years after initial thyroidectomy. A. Microscopic photomicrograph illustrates that small nests of tumor cells are predominantly solid and focally contain eosinophilic colloidal materials (short thick black arrows). The neoplastic cell nests show increased mitosis and locate within cells of a mammary duct and interstitium (long thin black arrow) (original magnification, × 200; H&E stain). B, C. Immunohistochemical staining shows the tumor cells are positive for TTF1 (B) and thyroglobulin (C), which appear brown suggestive of thyroid tissue origin (original magnification, × 400). Scanty expression of thyroglobulin and increased Ki-67 labeling index confirms thyroid carcinoma with poor differentiation. H&E = hematoxylin and eosin, TTF1 = thyroid transcription factor-1

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