Plonczak Agata M, DiMarco Aimee N, Dina Roberto, Gujral Dorothy M, Palazzo Fausto F
Department of Thyroid & Endocrine Surgery, Hammersmith Hospital, Imperial College Hospitals NHS Trust, London, W12 0HS, UK.
Department of Histopathology, Hammersmith Hospital, Imperial College Hospitals NHS Trust, London, W12 0HS, UK.
J Med Case Rep. 2017 Sep 22;11(1):269. doi: 10.1186/s13256-017-1441-x.
Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature.
A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy.
A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally indicates poor prognosis, obviating the need of surgery in an already compromised patient. An empirical thyroidectomy should be considered in select patients for local disease control.
甲状腺转移瘤较为罕见。转移至甲状腺的最常见原发癌是肾细胞癌，其次是胃肠道、肺和皮肤的恶性肿瘤，乳腺癌转移至甲状腺则较为罕见。总体而言，转移至甲状腺的恶性肿瘤预后较差。目前尚无前瞻性研究探讨手术在甲状腺转移瘤疾病中的作用。孤立性甲状腺切除术已被提议作为一种局部疾病控制选择，以缓解并预防与气道相关的肿瘤扩展的潜在并发症。在此，我们报告一例乳腺癌转移至甲状腺的患者病例，并结合当前文献讨论甲状腺切除术的作用。
一名62岁的非洲加勒比裔女性于2004年被诊断为双侧乳腺癌，随后接受了双侧乳房切除术。病理显示右侧为多灶性病变，T2N0(0/20)M0 1级和2级浸润性导管癌，左侧为T3N1(2/18)M0 1级浸润性导管癌。手术后进行了辅助化疗和区域放疗。该疾病在激素治疗下得到控制，直到2016年，她出现了颈部淋巴结病。甲状腺细针穿刺细胞学检查报告为乳头状甲状腺癌；左侧颈部淋巴结病的细针活检更提示为乳腺恶性肿瘤。她接受了全甲状腺切除术、中央区淋巴结清扫术以及颈部淋巴结病活检。组织病理学分析结果与甲状腺及淋巴结中的转移性乳腺癌一致，未发现原发性甲状腺恶性肿瘤的证据。
既往有其他部位恶性肿瘤病史的患者，出现有或无颈部淋巴结病的甲状腺肿块时，应提高对转移性疾病的怀疑指数。甲状腺转移瘤的发现通常预示预后不良，对于本就身体状况不佳的患者无需进行手术。对于部分患者，为控制局部疾病可考虑经验性甲状腺切除术。
