Métastase rénale d’un carcinome vésiculaire de la thyroïde révélée par le balayage du corps entier à l’iode 131

Distant metastasis of differentiated thyroid carcinoma generally affect lung and/or bone tissue. Renal metastasis from thyroid carcinoma is extremely rare. We report a case of renal metastasis from a follicular thyroid carcinoma in a 55-year-old man, occuring 11 years after total thyroidectomy, fortuitously discovered on a whole body scan carried out after 131-iodine therapy for neck recurrence of disease. Salient features of our clinical case are the fortuitous mode of discovery the unilateral localization of metastases and especially the long time interval which separates its detection from that of the primitive tumour. This case report exemplifies the useful role of the whole body scan carried out after 131-iodine therapy better adapted to reveal often undetectable occult metastases with low dose, but also to ensure a regular and protracted follow-up of patients treated for differentiated thyroid carcinoma.     

Métastase méningée révélatrice de cancer thyroïdien multimétastatique

We report the case of a 74-year-old patient who presented with cognitive disorders. Morphological imaging showed a tumor which was considered as a meningioma. Surgical resection of this tumor was performed and pathology indicated a meningeal metastasis of a thyroid cancer. The patient had previously a thyroidectomy with an initial benign pathology report. Meningeal metastases of thyroid cancer are rare, and a meningeal metastasis revealing a thyroid cancer is very rare.     

Pituitary metastasis of follicular thyroid carcinoma

OBJECTIVE: The case of a 60-year-old male patient with follicular thyroid cancer who developed a pituitary mass proved to be a metastasis from thyroid cancer. METHODS: Assessment with whole-body scan, ultrasound, computed tomography and thyroglobulin measurements. RESULTS: Despite surgery and repeated doses of radioiodine, the patient developed diplopia and ptosis of the right eyelid, along with increasing thyroglobulin levels. A pituitary mass was discovered, with no signs of pituitary deficiency. The mass was removed and found to consist of neoplastic cells immunohistochemically positive to thyroglobulin. CONCLUSIONS: Distant metastases may develop in cases of follicular thyroid carcinoma, even after repeated doses of (131)I. Metastatic follicular thyroid carcinoma to the pituitary is a rare entity.     

Association hyperthyroïdie et cancer thyroïdien différencié (médullaire exclu). À propos de sept observations

The aim of this study was to draw attention to the fact that hyperthyroidism does not exclude the possibility of concurrent thyroid carcinoma. We analyzed the frequency and consequences of this association through seven cases of thyrotoxic patients with differentiated thyroid carcinoma followed by a review of literature.

Patients and methods

The nuclear medicine department of the CHU Ibn Sina has more than 3000 cases of differentiated thyroid carcinoma where 10 patients with association of hyperthyroidism could be retrieved. Our study focused on seven cases well documented and regularly followed. The main parameters collected were the following: age, sex, personal and family history of thyroid disease, clinical presentation, etiology of hyperthyroidism, preoperative paraclinical explorations, surgery performed, histopahological findings, complementary therapy and follow-up.

Results

Group included six females and one male, average age was 41.4 years. There were four cases of Graves’ disease, two cases of single toxic nodule and one case of functional multinodular goiter. All patients underwent total thyroidectomy. Final pathologic examination disclosed five papillary carcinomas and two follicular carcinomas. During 2 to 8 years follow-up, there was neither local recurrence nor metastasis.

Conclusion

The diagnosis of hyperthyroidism does not preclude concurrent thyroid carcinoma. Careful assessment of such patients is mandatory to exclude an associated thyroid malignancy particularly in the presence of a nodule in a hyperfunctioning thyroid.     

Irathérapie génique anticancéreuse utilisant le NIS : une approche très prometteuse

The symporter Na/iodine (NIS) is a recently discovered membrane protein, recognized to be at the origin of accumulation of iodine in the thyroid, salivary glands, stomach and mammary glands during lactation. If its intrinsic property served as the basis for nuclear imaging and radiotherapy metabolic of differentiated thyroid cancers and their metastases, the cloning of its gene provides a powerful strategy for cytoreductive gene therapy, based on the targeted transfer of this last one in all types of cancer cells. Its expression gives the ability to these cells to accumulate iodine. The aim is to benefit from the advantages of radioiodine therapy (efficiency, reduced side effects) and to optimize the management of thyroid cancer. This approach offers an attractive therapeutic alternative for non-thyroidal cancers, especially in the context of a multimodal approach. Techniques and equipments necessary for the first clinical trials are already existing in the departments of nuclear medicine. The perspectives of clinical application, however, require a better knowledge of the regulation of expression and functionality of NIS. After a review of the biology of NIS, our work aims to recount the results of different tests that have demonstrated the benefits of this approach, its limitations and prospects for its improvement.     

Métastase du tissu mou révélant un carcinome folliculaire différencié de la thyroïde

Differentiated thyroid cancer occupies a very important place within the framework of thyroid pathology, representing 90% of thyroid cancers. A nodular goiter generally summarizes the clinical picture. Nevertheless, remote metastases can be revealing. The elective localizations of these metastases are by descending order of frequency: lung, bone, mediastinal lymph nodes, kidney, liver and adrenal glands. Soft tissue metastases are extremely rare and exceptionally revealing of the neoplasm. We report one case of follicular thyroid carcinoma revealed by soft tissue metastases of the arm.     

Fixations extra-osseuses du Tc MDP dans le cas d’un cancer du sein métastatique à l’os

Aim

To report and discuss an unusual visceral uptake on bone scan in a case of breast cancer with bone metastases.

Patient and methods

A 40-year-old woman, with untreated bilateral breast cancer was referred to our department for a bone scan.

Results

The bone scan evidenced multiple metastases over the axial skeleton. Uncommonly, visceral uptake was noted associating diffuse bilateral lung uptake and intense myocardium, stomach and kidneys uptakes. Serum calcium level was high: 4.08 mmol/L (normal: 2.38–2.70 mmol/L).

Conclusion

The incidental observation of metastasic calcifications on bone scan is often related to severe hypercalcemia. Such pattern should alert the physician on the existence and the severity of calcium metabolism disturbances that had not been suggested before.     

Parathyroid involvement in thyroid cancer: an unforeseen event

ABSTRACT: BACKGROUND: Parathyroid metastatic disease from thyroid cancer has not been studied extensively, mainly due to the need for parathyroid preservation during thyroid surgery. METHODS: We reviewed files from 1,770 patients with thyroid cancer followed up in our department and 10 patients with parathyroid metastases (0.5 %) were identified. Patient and tumor characteristics were recorded. RESULTS: Six out of ten patients had metastasis from papillary thyroid cancer, three from follicular thyroid cancer and one from anaplastic thyroid cancer. In nine patients parathyroid infiltration from thyroid cancer was found in direct contact with the thyroid cancer, and in one patient metastatic foci were observed not in continuity with the thyroid cancer. CONCLUSIONS: Parathyroid involvement, although infrequent, may occur in thyroid cancer independently of patient age and tumor size. The clinical significance of such event is not clear. The influence on disease outcome remains to be elucidated.     

Fine needle aspiration cytology of metastatic scalp nodules

OBJECTIVE: To analyze cases of palpable cutaneous/ subcutaneous scalp nodules and evaluate the clinical features and role of fine needle aspiration cytology (FNAC) in their diagnosis. STUDY DESIGN: A total of 1,022 cases of metastatic malignancies at various sites were analyzed over a period of two years. FNAC was performed as a routine outpatient procedure for palpable lesions and under ultrasound or computed tomographic guidance for nonpalpable, internal sites. Histologic correlation was done when possible. RESULTS: Eighteen cases were found to be metastatic scalp nodules. The scalp as a metastatic site constituted 1.76% of all metastatic sites, 7.72% of extranodal sites, and 15.3% of extranodal and extrahepatic sites. Of the 18 cases, 7 (38.9%) had primaries in the head and neck region (thyroid, 3; orbit, 1; tonsil, 1; tongue, 1; and parathyroid, 1). Cutaneous/subcutaneous metastasis was encountered in 58 patients, and the 18 cases of scalp metastasis constituted 31.03% of all cutaneous sites. CONCLUSION: Careful examination of the skin on the entire body, with particular attention to the scalp, should be done when a primary internal malignancy or recurrence is suspected. FNAC is a very helpful and cost-effective modality in determining the nature of such lesions.     

Isolated jejunal metastasis in a patient with cervical cancer: A case report

Background

In approximately 8% of cervical carcinoma patients, gastrointestinal tract is involved, most commonly the rectosigmoid portion, because of local extension. Isolated metastases to small bowel are exceedingly rare.

Case report

We present a case of a 63-year-old woman with cervical cancer who developed isolated jejunal metastasis 8 months after postoperative chemoradiotherapy. The patient was alive with no evidence of disease 6 months after resection of metastasis. Very few cases have been reported concerning squamous cell carcinoma of the cervix with documented metastases to the small bowel. There is only one published case report of cervical cancer with multiple metastases to the small intestine and jejunum. To our knowledge, this is the first case of cervical cancer with isolated jejunal metastasis, which was initially demonstrated with positron emission tomography and confirmed histopathologically.

Conclusion

Although the exact mechanism underlying the isolated metastasis is unknown, hematogenous spread or tumor seeding during surgery may play a role.     

Needle tract implantation of papillary carcinoma of the thyroid following aspiration biopsy

A case is reported of a slow-growing papillary carcinoma of the thyroid that caused clinically apparent implantation along the tract of a fine needle aspiration (FNA) biopsy. This appears to be the first report of a cutaneous needle tract metastasis from a papillary thyroid carcinoma. It represents a highly unusual complication of an FNA biopsy of an indolent, slow-growing tumor.     

Valeur pronostique du curage ganglionnaire prophylactique dans le cancer différencié de la thyroïde

Objective

Although the efficacy of total thyroidectomy as the first step in differentiated thyroid cancer (DTC) management is well proven, it is always a matter of controversy whether prophylactic lymph node dissection improves prognosis and survival in DTC patients without suspicion of lymph node metastases either clinically or radiologically. The aim of this work is to study relapse rates in patients according to the initial presentation and type of surgery performed, in order to analyze the prognostic impact of lymph node dissection.

Patients and methods

One hundred and thirty patients with DTC were classified according to clinical presentation and type of surgery performed. They were monitored for six years to watch for recurrence.

Results

In patients with no clinical evident lymph nodes, the relapse rate was lower among patients who underwent total thyroidectomy in one step with prophylactic lymph node dissection.

Conclusion

Based on the results of other studies, and on our department experience of thyroid cancer management and monitoring, we strongly advocate careful and systematic exploration of the central lymph node compartments with exploration of the lateral side of the lesion if in doubt.     

Métastases gingivales d’un carcinome thyroïdien différencié

The differentiated thyroid carcinoma metastases concern habitually the lymphatic chains, the bone, the lung, and to a lesser degree the other organs. We report a rare case of gingival metastasis of differentiated thyroid carcinoma with bony invasion, in a 50 year-old patient, in whom the gingival metastasis revealed the thyroid carcinoma. Such extension follows a protracted course. Metastasis clinically appears years after the diagnostic of initial tumour. The lack of any specific sign, makes them to be mistaken for inflammatory or infectious pathologies. Their prognosis is in general good, if they are early and accurately diagnosed.     

Métastase splénique isolée métachrone d’un adénocarcinome colique

Isolated splenic metastases of colorectal cancers are very rare but possible even after several years of remission. We report the case of a 74-year-old man who developed isolated metachronous splenic metastasis of left colon cancer 5 years after the treatment of the primary tumor. Splenic metastasis was found by imaging examinations. The patient underwent splenectomy and the histological examination confirmed the metastatic nature of the splenic lesion. 18F-FDG PET allows both staging and resectability of these isolated metachronous splenic metastasis because a long-term survival can be achieved by splenectomy.     

Intérêt du dosage de la thyroglobulinémie chez les sujets porteurs du goitre en zones de déficience iodée au Bénin

In the present study, we analyze the results of thyroid hormones and thyroglobulinemia of 162 patients with goiter living in the departments of Collines and Donga, known to be areas of iodine deficiency in Benin. These results are compared with those of 85 healthy subjects living in the same departments. This study is a cross-sectional analytical study carried out from 1st July 2009 to 30th June 2010. The population of patients consisted of seven males and 155 females. The average age was of 45.7 years. Most of the patients were suffering of simple goiter. Only six of them had thyroid nodules. The diagnosis of biological hyperthyroidism was positive for 20 patients; 16 of them had subclinical hypothyroidism and four clinical hyperthyroidism. One case of clinical hypothyroidism was found. All other 141 patients were biologically normal (euthyroidism). Seventeen of the patients (including six patients presenting a thyroid nodule) had a normal thyroglobulin rate. Hyperthyroglobulinemia was observed in all other 145 patients. These results suggest that patients with goiter in zone of iodine deficiency are biologically euthyroid with hyper-thyroglobulinemia. Thyroglobulin dosage is then recommended, especially when nodules are perceptible.     

Détection scintigraphique préopératoire de métastases pulmonaires d’un carcinome vésiculaire de la thyroïde associé à une hyperthyroïdie

Preoperative accumulation of radioiodine in metastases of thyroid carcinoma and its association with hyperthyroidism are uncommon. We report a case of 58-year-old woman with follicular thyroid carcinoma revealed by thyrotoxicosis caused by a hot nodule, and bilateral pulmonary uptake of I-131 before total thyroidectomy. Despite four ablative doses of I-131, bone metastases were identified and the patient died 42 month after the initial diagnosis.     

Transformation maligne d’un goitre ovarien. À propos d’une observation

Struma ovarii is a monodermal variant of ovarian teratoma, which predominantly contains thyroid tissue. Malignant transformation and metastasis are very rare. The treatment of malignant struma ovarii remains controversial. We report the case of a patient with a recurrent struma ovarii, treated 18 years ago. The malignant transformation and metastases were treated with a combination of surgery and I¹³¹ ablation therapy.     

Osteosarcoma with cutaneous metastases. A case report

BACKGROUND: Osteosarcomas, despite their aggressive nature and propensity to metastasize, only rarely give rise to skin deposits. CASE: We report a case of a femoral osteosarcoma in which cutaneous scalp and neck metastases developed 3 years after treatment of the primary disease. Fine needle aspiration was pivotal in diagnosing the secondary disease. CONCLUSION: Only 8 instances of cutaneous metastases from an osteosarcoma have been previously reported. We recommend early investigation of such nodules with fine needle aspiration cytology and inclusion of multiagent chemotherapy as part of the treatment protocol in all patients with osteosarcoma.