Metastases to the thyroid gland are more frequent than previously thought, although most of them are occult or not clinically relevant. Overall, only 42 cases of metastases to thyroid from breast cancer have been reported thus far. Here we report the case of a patient with breast cancer metastatic to the thyroid. We also review the 42 previously reported cases (published between 1962 and 2012). This is the first review about metastases to thyroid gland from breast cancer.
A 64-year-old woman of Caucasian origin was diagnosed with a lobular invasive carcinoma of the breast (luminal A, stage II). She received adjuvant chemotherapy, followed by endocrine therapy. During follow-up, fine-needle cytology of a thyroid nodule revealed malignant cells that were estrogen-positive, which suggested a diagnosis of metastases to the thyroid. Imaging did not reveal any other metastatic site and showed only enlargement of the left thyroid lobe and an inhomogeneous pattern of colloid and cystic degeneration and calcifications. The patient underwent left hemithyroidectomy. Histology of thyroid tissue showed a colloid goitre containing dispersed small atypical neoplastic cells with eccentric nuclei. Immunohistochemistry showed cytokeratin-19 and oestrogen receptor, but not tireoglobulin, e-cadherin or cytokeratin-7, thereby confirming metastases from a lobular breast carcinoma. Hormonal treatment is ongoing.
This case report and first review of the literature on metastases to thyroid from breast cancer highlight the importance of a correct early diagnostic work-up in such cases. Indeed, a primary lesion should be distinguished from metastases given the different treatment protocol related to primary cancer and the clinical impact on prognosis.
Cichon S, Anielski R, Konturek A, Barczynski M, Cichon W. Metastases to the thyroid grand: seventeen cases operated on in an single clinical center. Langenbeck's Arch Surg. 2006;391(6):581–7. CrossRef
Wood K, Vini L, Harmer C. Metastases to the thyroid gland: the Royal Marsden experience. Eur J SurgOncol. 2004;30(6):583–8. CrossRef
Calzolari F, Sartori PV, Talarico C, Parmeggiani D, Beretta E, Pezzullo L, Bovo G, Sperlongano P, Monacelli M, Lucchini R, Misso C, Gurrado A, D'Ajello M, Uggeri F, Puxeddu E, Nasi P, Testini M, Rosato L, Barbarisio A, Avenia N. Surgical treatment of intrathyroid metastases: preliminary results of a multicentric study. Anticancer Res 2008 Sep-Oct;28(5B):2885–8.
Papi G, Fadda G, Corsello SM, Corrado S, Rossi ED, Radighieri E, Miraglia A, Carani C, Pontecorvi A. Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin Endocrinol. 2007 Apr;66(4):565–71.
Diaconescu MR, Costea I, Glod M, Grigorovici M, Diaconescu S. Unusual malignant tumors of the thyroid gland. Chirurg. 2013;108:482–9.
Gerges AS, Shehata SR, Gouda IA. Metastasis to the thyroid gland: unusual site of metastasis. J Egypt Natl Canc Inst. 2006;18(1):67–72. PubMed
Kim TY, Kim WB, Gong G, Hong SJ, Shong YK. Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy. Clin Endocrinol. 2005, Feb;62(2):236–41. CrossRef
Secondary H-WJN. Neoplasm of the thyroid presenting as a goiter. J Clin Pathol. 1965;18:282–7. CrossRef
Angorn IB, Baker LW. Tumour metastasis to the thyroid gland. S Afr Med J. 1977 Apr 9;51(15):509–12. PubMed
Saber A, Ramzy S, Gouda I. Metastasis to the thyroid gland; unusual site of metastasis. Gulf J Oncolog. 2007 Jan;1(1):51–7. PubMed
Chaco MS, Greenebaum E, Moussouris HF, Schreiber K, Koss LG. Value of aspiration cytology of the thyroid in metastatic disease. Acta Cytol. 1987;31:705–12.
https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (last accessed 31/01/2017).
Vini L, Harmer C. Radioiodine treatment for differentiated thyroid cancer. Clin Oncol. 2000;12(6):365–72. CrossRef
Lam KY, Lo CY. Metastatic tumours of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med. 1998;122(1):37–41. PubMed
Pillay SP, Angorn IB, Baker LW. Tumour metastasis to the thyroid gland. S Afr Med J. 1977;Apr;51(15):509–12.
- It is no longer the time to disregard thyroid metastases from breast cancer: a case report and review of the literature
Giuseppe Di Lorenzo
Sabino De Placido
- BioMed Central
Neu im Fachgebiet Onkologie
Immunohistochemistry showing cytokeratin (left) and estrogen receptor (right)/© Pensabene et al., e.Med Kampagnen-Visual, Mail Icon II