Nath Vikas, Baliga Mithra, Lewin Jack, Souza Frederico, Akhtar Israh
Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Case Rep Pathol. 2015;2015:701413. doi: 10.1155/2015/701413. Epub 2015 Oct 13.
Here we report a case of a 45-year-old female who underwent thyroidectomy for thyroid cancer and presented 20 years later with a left renal mass. CT-guided core biopsy was performed, and imprints and histologic sections of the biopsy showed cells resembling thyroid follicular cells with a background containing colloid. Immunohistochemistry revealed positivity for thyroglobulin and thyroid transcription factor 1, consistent with metastatic follicular thyroid carcinoma (FTC). The patient later underwent radical nephrectomy; histologic sections of the resected tumor revealed an encapsulated lesion morphologically similar to the biopsy specimen. Thyroid metastases to the kidney are extremely rare and are often detected during postthyroidectomy surveillance by elevation in thyroid hormone levels, (131)I scintigraphy, or (18)F-fluorodeoxyglucose uptake in positron emission tomography studies. Treatment involves total thyroidectomy, resection of the metastatic foci, and (131)I therapy. The differential diagnoses of renal metastasis of FTC include the encapsulated follicular variant of papillary thyroid carcinoma (PTC), which possesses some of the nuclear features seen in conventional PTC but may occasionally be indistinguishable from FTC in cytologic preparations, and renal lesions such as benign thyroidization of the kidney and thyroid-like follicular carcinoma of the kidney, which mimic FTC in histologic appearance but do not stain with thyroid markers.
在此，我们报告一例45岁女性病例，该患者因甲状腺癌接受了甲状腺切除术，20年后出现左肾肿物。进行了CT引导下的核心活检，活检的印片和组织学切片显示细胞类似于甲状腺滤泡细胞，背景中有胶体。免疫组化显示甲状腺球蛋白和甲状腺转录因子1呈阳性，符合滤泡状甲状腺癌转移（FTC）。该患者随后接受了根治性肾切除术；切除肿瘤的组织学切片显示为一个有包膜的病变，形态上与活检标本相似。甲状腺转移至肾脏极为罕见，通常在甲状腺切除术后监测期间通过甲状腺激素水平升高、（131）I闪烁扫描或正电子发射断层扫描研究中的（18）F-氟脱氧葡萄糖摄取来检测。治疗包括全甲状腺切除术、转移灶切除和（131）I治疗。FTC肾转移的鉴别诊断包括甲状腺乳头状癌（PTC）的包膜滤泡变异型，其具有一些传统PTC中所见的核特征，但在细胞学制片中偶尔可能与FTC难以区分，以及肾脏病变，如肾脏的良性甲状腺化和肾脏的甲状腺样滤泡癌，其在组织学外观上模仿FTC，但不被甲状腺标志物染色。
