Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 1106-1115
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.1106
Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter: A case report and review of literature
Wen Wen, Heng Jiang, Hsin-Yu Wen, Yu-Lan Peng
Wen Wen, Yu-Lan Peng, 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
Author contributions: Wen W is the primary author and contributed to collecting and analyzing data, literature reviewing and manuscript drafting; H Jiang contributed to manuscript drafting and revising; Wen HY provided pathological analysis and manuscript revision; Peng YL was responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version submitted.
Supported by National Natural Science Foundation of China (General Program), No. 81571694 (to Peng YL).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Lan Peng, MBBS, Professor, Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Wai Nan Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. yulanpeng520@126.com
Received: July 24, 2021
Peer-review started: July 24, 2021
First decision: October 22, 2021
Revised: October 28, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
Processing time: 174 Days and 21.1 Hours
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.

Keywords: Metastases to the thyroid gland; Diffuse goiter; Cervical lymph node recurrence; Breast cancer; Case report

Core Tip: This is a case report of metastasis to the thyroid gland (TM) from primary breast cancer presenting as diffuse goiter associated with skip metastases (SMs) to the contralateral cervical lymph nodes. The patient presented with a cervical mass and progressive neck swelling that were found to be metastases with altered immunostaining profiles upon fine-needle aspiration cytology. These findings indicate that rapidly occurring diffuse goiter without nodules may be the first sign of TM and that enlarged lymph nodes in the contralateral cervical area may be SMs of breast cancer. Raising awareness of these clinical presentations is helpful for the early detection of metastatic disease.