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Guan Y, Ma Q, Zhang Y, Zhao J, Guo X. Thyroid Metastases from Breast Cancer Case Report and Literature Review. Curr Cancer Drug Targets 2025; 25:83-95. [PMID: 38409692 DOI: 10.2174/0115680096274465240129055950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Thyroid metastasis arising from primary breast cancer is a rare phenomenon, with only a handful of cases documented in both national and international literature. The management approach and prognosis of this occurrence have sparked debates and uncertainties. CASE PRESENTATION Herein, we report the case of a 55-year-old woman with breast cancer. She previously underwent extensive excision of the breast lesion with adjuvant chemotherapy and endocrine therapy. After 9 years, she presented with neck discomfort and examination suggested right thyroid metastasis and lymph node metastasis in the neck. Imaging showed pulmonary and bone metastases. Furthermore, the patient received endocrine therapy. After 7 months of follow- up, the patient survived without any new distant metastases. Thyroid metastases originating from breast cancer often unfold with a subtle, intricate nature, making early detection challenging. They tend to emerge inconspicuously, intertwining with widespread systemic metastases, hinting at a less favorable prognosis. CONCLUSION Given the unusual clinical indicators, identifying heterochronic thyroid metastases in patients with tumors poses a distinct challenge, requiring clinicians to navigate the follow-up process with heightened sensitivity. The key lies in timely detection and early intervention, factors that can significantly enhance the overall quality of life for patients.
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Affiliation(s)
- Yumei Guan
- Breast Disease Diagnosis and Treatment Center, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Qinjun Ma
- Pathology Department, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Yiqing Zhang
- Pathology Department, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Jiuda Zhao
- Breast Disease Diagnosis and Treatment Center, Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Xinjian Guo
- Pathology Department, Affiliated Cancer Hospital of Qinghai University, Xining, China
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Patrizio A, Ferrari SM, Stoppini G, Palmisano E, Elia G, Ragusa F, Paparo SR, Balestri E, Mazzi V, Botrini C, Proietti A, Famà F, Benvenga S, Antonelli A, Fallahi P. Thyroid Metastasis from Primary Breast Cancer. J Clin Med 2023; 12:jcm12072709. [PMID: 37048792 PMCID: PMC10095414 DOI: 10.3390/jcm12072709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Breast cancer (BC), the most commonly diagnosed malignancy, frequently metastasizes to the bone, lungs, brain and liver at advanced stages, whereas the thyroid gland represents a rare target site for secondary disease. We examined the most recent literature about thyroid metastasis (TM) from BC after we encountered a peculiar case of a 71-year-old woman who developed sudden dysphagia, severe hypothyroidism and hypoparathyroidism due to TM 18 years after the diagnosis of her primary cancer. Based on published data, the prevalence of TM in BC ranges from 3% to 34%, with a median onset time of 48.2 months, although longer time intervals are not infrequent. TM negatively impacts the prognosis of these patients, however thyroid surgery can limit the local disease burden. Therefore, we suggest that clinicians involved in the follow-up care of BC patients should consider a differential diagnosis of secondary thyroid malignancy when incidental lesions are diagnosed during radiological evaluations or local symptoms affect the cervical region, even many years after the diagnosis of the primary cancer.
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Affiliation(s)
- Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy
| | | | - Giulio Stoppini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Elena Palmisano
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Francesca Ragusa
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Rosaria Paparo
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Eugenia Balestri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Chiara Botrini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Agnese Proietti
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Fausto Famà
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98125 Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, 98125 Messina, Italy
- Interdepartmental Program of Molecular and Clinical Endocrinology and Women’s Endocrine Health, Azienda Ospedaliera Universitaria Policlinico “G. Martino”, 98125 Messina, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Wen W, Jiang H, Wen HY, Peng YL. Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter: A case report and review of literature. World J Clin Cases 2022; 10:1106-1115. [PMID: 35127926 PMCID: PMC8790461 DOI: 10.12998/wjcc.v10.i3.1106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Metastasis to the thyroid gland (TM) from primary breast cancer is uncommon and usually presents as thyroid nodules; however, diffuse goiter without thyroid nodules is the first sign of TM in rare cases. Skip metastases (SMs) to the lymph nodes in breast cancer, defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases, have been reported in the contralateral cervical area of the primary tumor site in rare cases.
CASE SUMMARY A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection. No malignancy of the left breast or axillary or distant metastases were identified preoperatively. However, enlarged left cervical lymph nodes were detected 36 mo after surgery, and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery. Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid, which were both revealed to contain metastases from the primary breast cancer. Additionally, the immunostaining profiles changed in the process of metastases. The patient was discharged with the NP (vinorelbine and cisplatin) regimen for subsequent treatment, and stable disease was determined when the curative effect was evaluated.
CONCLUSION Diffuse goiter may be the first sign of TM, and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.
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Affiliation(s)
- Wen Wen
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Heng Jiang
- College of Medicine, University of Nebraska Medical Center, Omaha, NE 68133, United States
| | - Hsin-Yu Wen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Lan Peng
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Pensabene M, Stanzione B, Cerillo I, Ciancia G, Cozzolino I, Ruocco R, Condello C, Di Lorenzo G, Giuliano M, Forestieri V, Arpino G, De Placido S, Lauria R. It is no longer the time to disregard thyroid metastases from breast cancer: a case report and review of the literature. BMC Cancer 2018; 18:146. [PMID: 29409458 PMCID: PMC5801832 DOI: 10.1186/s12885-018-4054-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/25/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND 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. CASE PRESENTATION 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. CONCLUSION 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.
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Affiliation(s)
- Matilde Pensabene
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy.
| | - Brigida Stanzione
- Department of Medical Oncology, National Cancer Institute, Aviano, PN, Italy
| | - Ivana Cerillo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Giuseppe Ciancia
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Immacolata Cozzolino
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Raffaella Ruocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Caterina Condello
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Sergio Pansini, 80131, Naples, Italy
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Manes K, Delis S, Papaspyrou N, Ghiconti I, Dervenis C. Neuroendocrine breast carcinoma metastatic to the liver: Report of a case and review of the literature. Int J Surg Case Rep 2014; 5:540-3. [PMID: 25024021 PMCID: PMC4147575 DOI: 10.1016/j.ijscr.2014.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Primary neuroendocrine breast carcinoma (NEBC) is a rare entity of breast cancer. PRESENTATION OF CASE We herein report a case of right hepatectomy for a NEBC liver metastasis. DISCUSSION Little is known about its evolution, bilologic behavior and optimal treatment. Its malignant potential has been addressed in few reports, with cases of metachronous metastases in diverse sites, even years following treatment of the breast primarily. CONCLUSION Treating this kind of cancer implies both breast and hepatic surgery. Primary neuroendocrine breast carcinoma (NEBC) is a rare entity of breast cancer. Little is known about its evolution, biologic behavior and optimal treatment. Its malignant potential has been addressed in few reports, with cases of metachronous metastases in diverse sites, even years following treatment of the breast primarily. We herein report a case of right hepatectomy for a NEBC liver metastasis.
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Affiliation(s)
- Konstantinos Manes
- Surgical Department, "Konstantopouleio" General Hospital, Athens, Greece.
| | - Spyridon Delis
- Surgical Department, "Konstantopouleio" General Hospital, Athens, Greece
| | | | - Ioanna Ghiconti
- Pathology Department, "Konstantopouleio" General Hospital, Athens, Greece
| | - Christos Dervenis
- Surgical Department, "Konstantopouleio" General Hospital, Athens, Greece
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Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade. Thyroid 2012; 22:258-68. [PMID: 22313412 DOI: 10.1089/thy.2010.0154] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although clinically evident metastases of nonthyroid malignancies (NTMs) to the thyroid gland are uncommon, it is important to suspect them in patients who present with a new thyroid mass and a history, however far back, of prior malignancy. In fact, metastases from NTMs to the thyroid gland have been reported in 1.4%-3% of all patients who have surgery for suspected cancer in the thyroid gland. Here we review the literature over the last decade regarding this topic. SUMMARY Based on recent literature, the most common NTMs that metastasize to the thyroid gland are renal cell (48.1%), colorectal (10.4%), lung (8.3%), and breast carcinoma (7.8%), and sarcoma (4.0%). Metastases of NTMs to the thyroid are more common in women than men (female to male ratio=1.4 to 1) and in nodular thyroid glands (44.2%). The mean and median intervals between diagnosing NTMs and their metastases to thyroid gland are 69.9 and 53 months, respectively. In 20% of cases the diagnosis of the NTM and its metastases to the thyroid was synchronous. Recent reports indicate that there is a higher frequency of sarcoma metastasizing to the thyroid gland than reported in prior years. Fine-needle aspiration biopsy (FNAB) of thyroid masses is useful in diagnosis of thyroid metastases. However, this requires information about the NTM so that the proper antibodies can be used for immunohistochemical analysis; therefore it is of lesser utility if the NTM is occult. In patients with preexisting thyroid pathology the FNAB diagnosis can be more difficult due to more than one lesion being present. CONCLUSIONS It is important to keep in mind that the thyroid gland can be a site of metastases for a variety of tumors when evaluating a thyroid nodule, especially in a patient with a prior history of malignancy. In patients with thyroid lesions and a history of malignant disease, regardless of time elapsed since the initial diagnosis of the primary neoplasm, disease recurrence or progression of malignancy must be considered until proven otherwise.
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Affiliation(s)
- Alice Y Chung
- Department of Surgery, University of California San Diego, La Jolla, California 92093, USA
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McIntire M, Siziopikou K, Patil J, Gattuso P. Synchronous metastases to the liver and pancreas from a primary neuroendocrine carcinoma of the breast diagnosed by fine-needle aspiration. Diagn Cytopathol 2008; 36:54-7. [PMID: 18064696 DOI: 10.1002/dc.20753] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Extrapulmonary neuroendocrine carcinoma is uncommon. Cases of primary neuroendocrine carcinoma of the breast have been reported, though rare. We report the case of a 53-year-old woman who underwent a mastectomy for breast carcinoma and presented three years later with synchronous masses in the head of the pancreas and liver. Fine-needle aspiration of both organs revealed a neuroendocrine carcinoma. The original breast tumor was reviewed and found to express neuroendocrine markers. A diagnosis of a primary neuroendocrine carcinoma of the breast was rendered.
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Affiliation(s)
- Maria McIntire
- Department of Pathology, Rush University Medical Center, Chicago, Illinois 60618, USA
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Owens CL, Basaria S, Nicol TL. Metastatic breast carcinoma involving the thyroid gland diagnosed by fine-needle aspiration: a case report. Diagn Cytopathol 2005; 33:110-5. [PMID: 16007653 DOI: 10.1002/dc.20311] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Secondary involvement of the thyroid gland from a remote primary malignancy is uncommon. The distinction of metastatic carcinoma (MC) or sarcoma from a primary thyroid malignancy is important because the treatment is different. We discuss a case of a 64-yr-old female with a history of breast carcinoma, who presented with pain and swelling in her neck 5 yrs after being diagnosed with breast cancer. She had undergone mastectomy with subsequent chemotherapy and radiation for infiltrating mammary carcinoma. During the 5-yr interval, she had been free of clinically evident metastatic disease. Subsequent work-up revealed two distinct nodules in the left lobe of her thyroid gland as well as a subcutaneous mass in her right shoulder. A fine-needle aspiration (FNA) of the larger thyroid nodule showed malignant epithelial cells with features consistent with breast carcinoma in a background of benign thyroid epithelial cells and colloid. The case was signed out as metastatic breast carcinoma. Subsequent FNA and biopsy of her right shoulder lesion also revealed metastatic breast carcinoma with similar morphology to the material in the thyroid FNA.
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Affiliation(s)
- Christopher L Owens
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Saqi A, Oster MW, Vazquez MF. Metastatic mammary carcinomas with endocrine features: Potential diagnostic pitfalls. Diagn Cytopathol 2005; 33:49-53. [PMID: 15945084 DOI: 10.1002/dc.20298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mammary carcinomas with endocrine differentiation (MCED) are an uncommon subtype of breast carcinomas that are morphologically indistinguishable from low-grade endocrine neoplasms arising in other organs. Aspirates of MCED yield relatively monotonous cells with eccentrically placed nuclei containing characteristic "salt and pepper" chromatin. In the breast, these features represent MCED. In extramammary sites, the differential is more extensive, and diagnosing MCED metastases to the lung, a common location for primary and metastatic endocrine tumors, can be a challenging task, with significant clinical implications. Although primary MCED have been described extensively in the cytology literature, secondary pulmonary MCED have not been reported to the best of our knowledge. We report three cases of MCED metastatic to the lung and present the cytological and immunohistochemical features.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York 10032, USA.
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