Rectal Adenocarcinoma Metastatic to the Thyroid Gland: Report of a Case with Review of Literature
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Rectal Adenocarcinoma Metastatic to the Thyroid Gland: Report of a Case with Review of Literature Priti Trivedi & Rohit Jain & Phulkumari Talukdar & Trupti Patel & Manoj Shah
Published online: 28 May 2008 # Humana Press Inc. 2008
Keywords colorectal cancer . thyroid . metastasis
Introduction Thyroid metastasis is rare, although microscopic metastasis to the thyroid is not uncommon, having been reported in 4% to 9% of autopsy studies [1, 2]. They most commonly arise from renal, lung, and breast carcinomas. Thyroid metastasis of colorectal origin seems to be very rare, as several large series of patients with thyroid metastasis did not report it [3, 4]. There are only 32 reported cases of thyroid metastasis that were clinically evident before death being caused by metastatic colorectal cancer [5, 6]. Thyroid metastasis may be associated with metastasis to other sites, like lung, liver, and adrenal, and hence, the prognosis seems to be very poor. In this paper, we present a rare case of isolated thyroid metastasis treated 8 years back for primary rectal cancer (modified stage Duke’s C2), TNM stage (T3N1M0) without metastasis to any other site. Case Report A 30-year-old female patient underwent abdominoperineal resection up to the sigmoid colon with sigmoidostomy at an outside hospital in October 1999. Her histopathology report revealed moderately differentiated adenocarcinoma, modiP. Trivedi (*) : R. Jain : P. Talukdar : T. Patel : M. Shah Department of Pathology, Research Building, The Gujarat Cancer and Research Institute, New Civil Campus, Room # 412, Asarwa, Ahmedabad, Gujarat 380016, India e-mail: [email protected]
fied Duke’s stage C2, and referred to our hospital for adjuvant radiotherapy and chemotherapy. Serum carcinoembryonic antigen (CEA) level was normal (2.0 ng/ml). She received 5 FU 425 mg/m2 and leucovorin 20 mg/m2 (day 1 to day 5) and external radiotherapy. She presented again in May 2007 with a midline swelling in the neck of 1-year duration. Clinically, left lobe of thyroid was enlarged, which moved on deglutition. Thyroid function tests (T3, T4, TSH) were normal. Serum CEA level was elevated (17.0 ng/ml). Ultrasonography abdomen and computed tomography (CT) scan thorax were normal. Fine-needle aspiration from the thyroid swelling was reported as a malignant adenocarcinoma suggesting a metastasis from the colorectal cancer, morphologic features uncharacteristic of the common primary tumor of thyroid. Patient then underwent total thyroidectomy with modified neck dissection. Grossly, left lobe was enlarged showing a 5×4-cm-sized tumor with homogenous a gray white firm cut surface. Right lobe and isthmus were grossly unremarkable. Several lymph nodes were dissected; largest lymph node was 1.5 cm in size with a homogenous gray white firm cut surface. Histologically, left lobe of thyroid showed malignant glands infiltrating the normal thyroid parenchyma with interstitial fibrosis. Glands showed tall columnar cells accompanied by central necrosis that favored metastatic colonic adenocarcinoma (Figs
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