Int J Thyroidol.  2023 Nov;16(2):190-194. 10.11106/ijt.2023.16.2.190.

A Case of Metastatic Prostate Cancer to the Thyroid Gland with Features of Anaplastic Thyroid Cancer

• Lee SY
• Kim YJ
• Oh SJ
• Lee HS

• KMID: 2548747
• DOI: http://doi.org/10.11106/ijt.2023.16.2.190

Abstract

Prostate cancer is one of the most frequent malignancies in men, and it has metastasis mainly to bones and lungs. Metastasis to cervical region is rare, and thyroid gland is one of the rarest organs with only few reports. In this case, we discuss a rare case of metastatic prostate cancer to thyroid gland and cervical lymph nodes, showing features similar to those of anaplastic thyroid cancer. A 73-year-old man with a history of prostate cancer was referred to our hospital with neck mass suggestive of anaplastic thyroid cancer, detected by fine-needle aspiration. Further examinations, including core needle biopsy, were done and it was confirmed as metastasis of prostate cancer. We focused on shortcomings of fine-needle aspiration and advantages of core-needle biopsy to avoid misdiagnosis. In addition, before diagnosis of head and neck cancer, patient’s history of other carcinomas must always be considered during differential diagnosis of metastatic lesions.

Keyword

Metastatic prostate cancer; Core needle biopsy; Anaplastic thyroid cancer

Figure

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  Fig. 1 Patient’s neck computerized tomography images and neck ultrasonography images. (A) Neck CT axial view shows a huge mass of left thyroid with suspected extrathyroidal extension and a right thyroid nodule. (B) Neck CT axial view shows multiple metastatic lymph nodes in the left lateral neck. (C) Neck US transverse view shows heterogenous mass of approximately 6.6 cm in size occupying the total left thyroid lobe. (D) Multiple heterogeneous lymph nodes (arrows) which show features of metastatic lymph nodes in left level II.

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  Fig. 2 Microscopic features of metastatic prostatic adenocarcinoma. (A) Core-needle biopsy of the left supraclavicular lymph node illustrates infiltration of atypical hyperchromatic cells in the hyalinized stroma. Poorly-formed glandular structures are identified (arrows) (Hematoxylin and Eosin [H&E] stain, ×200). (B) Tumor cells show a positive reaction on immunohistochemical stain for AMACR, a specific marker for prostatic carcinoma (original magnification ×200). (C) The thyroid gland reveals atypical cell clusters (arrows) (H&E stain, ×200) between normal thyroid follicles, which are positive for PSA, which is another marker of prostatic gland origin (original magnification ×200) (D).

Reference

References

1. Rawla P. 2019; Epidemiology of prostate cancer. World J Oncol. 10(2):63–89. DOI: 10.14740/wjon1191. PMID: 31068988. PMCID: PMC6497009.

2. Bubendorf L, Schöpfer A, Wagner U, Sauter G, Moch H, Willi N, et al. 2000; Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol. 31(5):578–83. DOI: 10.1053/hp.2000.6698. PMID: 10836297.

3. Ljung BM, Drejet A, Chiampi N, Jeffrey J, Goodson WH 3rd, Chew K, et al. 2001; Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer. 93(4):263–8. DOI: 10.1002/cncr.9040. PMID: 11507700.

4. Bayram F, Soyuer I, Atmaca H, Demirci D, Gokce C, Canoz O, et al. 2004; Prostatic adenocarcinoma metastasis in the thyroid gland. Endocr J. 51(4):445–8. DOI: 10.1507/endocrj.51.445. PMID: 15351802.

5. Ro JY, Guerrieri C, el-Naggar AK, Ordóñez NG, Sorge JG, Ayala AG. 1994; Carcinomas metastatic to follicular adenomas of the thyroid gland. Report of two cases. Arch Pathol Lab Med. 118(5):551–6. PMID: 7514864.

6. Selimoglu H, Duran C, Saraydaroglu O, Guclu M, Kiyici S, Ersoy C, et al. 2007; Prostate cancer metastasis to thyroid gland. Tumori. 93(3):292–5. DOI: 10.1177/030089160709300312. PMID: 17679467.

7. Gilani SM, Khan M, Barbieri A, Prasad ML. 2021; Anaplastic thyroid carcinoma: diagnostic challenges, histopathologic features and ancillary testing. Diagn Histopathol. 27(6):263–71. DOI: 10.1016/j.mpdhp.2021.03.004.

8. Ahmed S, Ghazarian MP, Cabanillas ME, Zafereo ME, Williams MD, Vu T, et al. 2018; Imaging of anaplastic thyroid carcinoma. AJNR Am J Neuroradiol. 39(3):547–51. DOI: 10.3174/ajnr.A5487. PMID: 29242360. PMCID: PMC7655324.

9. Pasieka JL. 2003; Anaplastic thyroid cancer. Curr Opin Oncol. 15(1):78–83. DOI: 10.1097/00001622-200301000-00012. PMID: 12490766.

10. Ha EJ, Baek JH, Lee JH, Kim JK, Song DE, Kim WB, et al. 2016; Core needle biopsy could reduce diagnostic surgery in patients with anaplastic thyroid cancer or thyroid lymphoma. Eur Radiol. 26(4):1031–6. DOI: 10.1007/s00330-015-3921-y. PMID: 26201291.

11. Us-Krašovec M, Golouh R, Auersperg M, Bešič N, Ruparčič-Oblak L. 1996; Anaplastic thyroid carcinoma in fine needle aspirates. Acta Cytol. 40(5):953–8. DOI: 10.1159/000334007. PMID: 8842172.

12. Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. 2013; Ultra-sonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results? Br J Radiol. 86(1025):20130007. DOI: 10.1259/bjr.20130007. PMID: 23564885. PMCID: PMC3635802.

13. Kraft M, Laeng H, Schmuziger N, Arnoux A, Gürtler N. 2008; Comparison of ultrasound-guided core-needle biopsy and fine-needle aspiration in the assessment of head and neck lesions. Head Neck. 30(11):1457–63. DOI: 10.1002/hed.20891. PMID: 18798314.