Follicular Thyroid Carcinoma Presenting as a Massive Chest Wall Tumor
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Follicular Thyroid Carcinoma Presenting as a Massive Chest Wall Tumor Ryan Gertz & Rakesh Sarda & Ricardo Lloyd
Published online: 11 December 2012 # Springer Science+Business Media New York 2012
Abstract The initial presentation of follicular thyroid carcinoma is rarely related to metastatic lesions. Presented here is the case of a 70-year-old woman with the initial presentation of a 13-cm chest wall mass identified as a metastatic follicular thyroid carcinoma. The chest wall lesion had features of a poorly differentiated carcinoma with areas of necrosis, an insular growth pattern focally and increased mitotic activity. A small follicular carcinoma was subsequently identified. The primary tumor was a 1-cm well-differentiated follicular carcinoma with capsular and vascular invasion. This represents a rare presentation of a follicular thyroid carcinoma with initial recognition of a large, dedifferentiated metastatic lesion from a small primary carcinoma. Dedifferentiation and metastasis in the context of microcarcinoma is an exceptionally rare event and suggests other mechanisms may be involved in disease spread other than simply increased cell proliferation. Keywords Follicular thyroid carcinoma . Distant metastases . Poorly differentiated thyroid carcinoma . Dedifferentiation . Chest wall metastasis
R. Gertz (*) : R. Lloyd Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, 600 Highland Avenue, Madison, WI 53792, USA e-mail: [email protected] R. Lloyd e-mail: [email protected] R. Sarda Department of Pathology, Meriter Hospital, 36 South Brooks Street, Madison, WI 53715, USA e-mail: [email protected]
Introduction Follicular thyroid carcinoma (FTC) generally carries a favorable prognosis with 10-year survival rates of 80–81 % although prognosis is affected by age, size of tumor, extrathyroidal extension, and the presence of distant metastasis [1, 2]. Patients with FTC will present with distant metastasis in 5–19 % of cases [1–5], which is significantly higher than in the more common papillary thyroid carcinoma [3, 5]. Such invasive disease predicts a lower long-term survival [1–3] and often prompts additional surgical intervention, external beam radiotherapy, and radioactive iodine treatment. The initial presentation of a large metastasis of FTC in the context of an initially unrecognized primary has rarely been reported in the literature [6], and distant metastases from microcarcinomas are rare [7, 8]. We report a unique case of a patient initially presenting with a chest wall mass identified as metastatic dedifferentiated follicular thyroid carcinoma. Postoperative evaluation revealed follicular carcinoma in the thyroid as an exceptionally small primary tumor in relation to the metastatic lesion. This case report supports the observation that follicular carcinomas can dedifferentiate to poorly differentiated thyroid carcinomas and that even small (1 cm diameter) carcinomas without extrathyroidal extension carry metastatic potential.
Case Report A 70-year-old woman presented with a
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