Endocrinol Metab.  2014 Dec;29(4):579-583. 10.3803/EnM.2014.29.4.579.

Solitary Skin Metastasis of Papillary Thyroid Carcinoma

• Kwon H
• Kim H
• Park S
• Song DE
• Kim WG
• Kim TY
• Shong YK
• Kim WB

• KMID: 2384258
• DOI: http://doi.org/10.3803/EnM.2014.29.4.579

Abstract

A solitary skin metastasis is a rare manifestation of papillary thyroid carcinoma (PTC). A 55-year-old woman presented with a movable subcutaneous nodule in her anterior neck for several months. Three years ago, she underwent total thyroidectomy and remnant ablation for classical PTC (pT3N0M0) and was under thyroxine suppression therapy without any evidence of recurrent disease. The subcutaneous nodule was 0.4 cm in size, firm, and movable without any change in the overlying skin. Recurrent PTC was confirmed after excision biopsy. Eight months after, she got a new nodule along the previous excision site. After punch biopsy, metastatic PTC was confirmed in the deep dermis and was re-excised with a clear resection margin. This is the first report of a case of solitary skin metastasis of PTC in Korea. Although solitary skin metastasis of PTC is rare, it should be considered in patients with a skin nodule.

Keyword

Thyroid neoplasms; Thyroid cancer, papillary; Skin metastasis

MeSH Terms

Biopsy
Dermis
Female
Humans
Korea
Middle Aged
Neck
Neoplasm Metastasis*
Skin*
Thyroid Neoplasms*
Thyroidectomy
Thyroxine
Thyroxine

Figure

• 

  Fig. 1 Gross and histological findings of solitary skin metastasis after initial surgery and radioiodine remnant ablation for papillary thyroid carcinoma (PTC). (A) A 0.4×0.6 cm sized cutaneous nodule on the anterior neck. (B, C) Histopathological findings after H&E stain of skin metastasis of PTC (×10 and ×400). (D, E) Histopathological findings after thyroid transcriptional factor 1 immunostaining (×10 and ×400). (F, G) Histopathological findings after thyroglobulin immunostaining (×10 and ×400).

• 

  Fig. 2 The results of imaging studies to evaluate the presence of local recurrence or distant metastasis at the time of initial skin metastasis. (A) Neck ultrasound findings. (B) Chest computed tomography. (C) F-18 fluorodeoxyglucose positron emission tomography scan.

Reference

1. Cho SW, Choi HS, Yeom GJ, Lim JA, Moon JH, Park do J, Chung JK, Cho BY, Yi KH, Park YJ. Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors. Thyroid. 2014; 24:277–286.

2. Somoza AD, Bui H, Samaan S, Dhanda-Patil R, Mutasim DF. Cutaneous metastasis as the presenting sign of papillary thyroid carcinoma. J Cutan Pathol. 2013; 40:274–278.

3. Shaha AR, Ferlito A, Rinaldo A. Distant metastases from thyroid and parathyroid cancer. ORL J Otorhinolaryngol Relat Spec. 2001; 63:243–249.

4. Park S, Jeong JS, Ryu HR, Lee CR, Park JH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. Differentiated thyroid carcinoma of children and adolescents: 27-year experience in the yonsei university health system. J Korean Med Sci. 2013; 28:693–699.

5. Nixon IJ, Whitcher MM, Palmer FL, Tuttle RM, Shaha AR, Shah JP, Patel SG, Ganly I. The impact of distant metastases at presentation on prognosis in patients with differentiated carcinoma of the thyroid gland. Thyroid. 2012; 22:884–889.

6. Dahl PR, Brodland DG, Goellner JR, Hay ID. Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol. 1997; 36:531–537.

7. Alwaheeb S, Ghazarian D, Boerner SL, Asa SL. Cutaneous manifestations of thyroid cancer: a report of four cases and review of the literature. J Clin Pathol. 2004; 57:435–438.

8. Ronga G, Colandrea M, Montesano T, Travascio L, Di Nicola AD, Giannasio P, Bruno R. Solitary skin metastasis from papillary thyroid carcinoma. Thyroid. 2007; 17:477–478.

9. Kwak JY. Indications for fine needle aspiration in thyroid nodules. Endocrinol Metab (Seoul). 2013; 28:81–85.

10. Polyzos SA, Anastasilakis AD. Clinical complications following thyroid fine-needle biopsy: a systematic review. Clin Endocrinol (Oxf). 2009; 71:157–165.

11. Polyzos SA, Anastasilakis AD. A systematic review of cases reporting needle tract seeding following thyroid fine needle biopsy. World J Surg. 2010; 34:844–851.

12. de Giorgi V, Alfaioli B, Massi D, Wnekowicz E, Sestini S, Papi F, Grazzini M, Lotti T. Solitary cutaneous metastasis as the first sign of relapse of thyroid carcinoma: a clinical, dermoscopic-pathologic case study. Dermatol Surg. 2009; 35:523–526.

13. Hoie J, Stenwig AE, Kullmann G, Lindegaard M. Distant metastases in papillary thyroid cancer. A review of 91 patients. Cancer. 1988; 61:1–6.

14. Song HJ, Xue YL, Xu YH, Qiu ZL, Luo QY. Rare metastases of differentiated thyroid carcinoma: pictorial review. Endocr Relat Cancer. 2011; 18:R165–R174.

15. Avram AM, Gielczyk R, Su L, Vine AK, Sisson JC. Choroidal and skin metastases from papillary thyroid cancer: case and a review of the literature. J Clin Endocrinol Metab. 2004; 89:5303–5307.

16. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A. Needle tract implantation of papillary thyroid carcinoma after fine-needle aspiration biopsy. World J Surg. 2005; 29:1544–1549.