Journal of Otology & RhinologyISSN: 2324-8785

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Case Report, J Otol Rhinol Vol: 3 Issue: 5

Thyroid Metastasis from Cardia Cancer

Martin Clarisse1, Touré Emmanuel2, Dehesdin Daniele1 and Choussy Olivier1
1Department of Otorhinolaryngology, Rouen University Hospital, Rouen,France
2Department of Pathology, Rouen University Hospital, Rouen, France
Corresponding author : Olivier Choussy
Service d’ORL et chirurgie cervicofaciale, CHU de ROUEN - Hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex -France,
Tel: 33232886614 Fax: 33232888359
E-mail: [email protected]
Received: June 11, 2014 Accepted: September 06, 2014 Published: September 10, 2014
Citation: Clarisse M, Emmanuel T, Daniele D, Olivier C (2014) Thyroid Metastasis from Cardia Cancer. J Otol Rhinol 3:5. doi:10.4172/2324-8785.1000184

Abstract

Thyroid Metastasis from Cardia Cancer

Objectives: The aim of the study was to present a case of gastric cardia cancer metastasis to thyroid gland.

Methods: this study includes a case report and review of the literature.

Results: The thyroid gland is an uncommon site of tumor metastasis but should always be suspected in any patients with a previous history of malignancy, mainly in kidney, breast and lung primary. To our knowledge, primary gastric cardia cancer with metastasis to the thyroid gland has only been reported in one case.

Conclusion: Metastases to the thyroid gland are rare but should always be suspected in any patient with a previous history of malignancy. Primary gastric cardia cancer is an extremely rare origin. Although detection of metastasis to the thyroid gland often indicates poor prognosis, surgical resection of an isolated metastasis can result in prolonged disease-free survival.

Keywords: Cardia cancer; Metastasis; Thyroid; Treatment

Keywords

Cardia cancer; Metastasis; Thyroid; Treatment

Introduction

The thyroid gland is an infrequent site of tumor metastasis even though the gland has a rich vascular supply. Kidney, breast and lung are the most frequent sites of primary malignancy. Thyroid metastases can be synchronous or metachronous with respect to primary tumor detection and, in this latter case, they can be clinically relevant even more than 10 years after primary localization diagnosis. The metastatic spreading to the thyroid gland can be influenced by some factors like the filtery activity of lungs, the high concentration of oxygen and iodine in the thyroid, and the local cytoregulating effect of the thyroid hormones. Moreover, the Batson’s venous plexus between the vertebral and epidural venous system can facilitate this spread, so that metastatic cells can bypass the pulmonary capillary filtration and metastasize in the head and neck region [1]. To our knowledge, primary gastric cardia cancer has only been reported once. We report a rare case of thyroid gland metastasis.

Case Report

An 88-year-old man presented urgently to our Department of Otorhinolaryngology for dyspnea. His previous medical history included a gastrectomy with radiotherapy and chemotherapy for gastric cardia cancer (pT3 N1 M0 R1) which was diagnosed one year previously. This lesion was classified as T3 because is growing into the subserosa layer and N1 because the cancer has spread to 1 paracardial lymph node. The patient had no other significant medical history. Physical examination revealed a major neck mass, sudden dyspnea, stridor, dysphonia and progressive worsening of dysphagia. A flexible laryngoscopy revealed left vocal cord palsy. Thyroid-stimulating hormone, free triiodothyronine (2.9mmol/L normal ranges 1.07- 3.37 mmol/L) and thyroglobulin (33 μg/L normal ranges 5-40 μg/L) rates were all normal. Computed tomography (CT) scan of the neck revealed a heterogeneous thyroid gland with necrotic adenopathy (Figure 1). No other metastasis foci were present. A tracheotomy was performed because of increasing dyspnea. Macroscopically, there was a massive infiltration of a hard, hemorrhagic with irregular borders thyroid gland. Consequently, the tracheotomy was performed through the mass and an excisional biopsy of the thyroid was carried out in the same time for histological examination. Pathologic examination (Figure 2) revealed an epithelial tumoral proliferation with tubuloglandular structures, and a fibrous stromal reaction. Alcian blue staining showed muco-secretion. Immunohistochemical staining demonstrated a positive reaction for cytokeratin 7 and cytokeratin 20 and a negative reaction for thyroid transcription factor 1(ttf1). Histology and immunohistochemistry identified the thyroid mass as a metastatic gastric carcinoma. Few days after the surgical procedure, the patient was getting worse and he died one week later.
Figure 1: Cervical CT scan - heterogenic thyroid.
Figure 2: Pathologic examination. a. Tumoral proliferation with tubuloglandular structures; b. High fibrous stromal reaction; c. Alcian blue staining is positive (mucosecretion); d. Positive reaction with cytokeratin 7 and 20.
This text was reviewed and accepted by the ethics committee of the Rouen University Hospital.

Discussion

Thyroid gland metastases (TM) are rarely observed in clinical practice. TM represent between 1.15% and 3% [1-3] of thyroid cancers and less than 0.15% of thyroid disease [4]. Conversely, the incidence of TM is higher in autopsy series with rates from 1.25% in unselected autopsy series to 24 % in patients with a widespread malignant neoplasm. Kidney, breast and lung cancers are the most frequent malignancies that metastasize to the thyroid gland [5]. However in the autopsy population, the highest incidence of metastasis to the thyroid occurs in malignant melanoma. Furthermore, in reported Asian series, organs of the gastrointestinal tract have been reported as the most frequent sites of primary TM [6]. To our knowledge, less than 15 cases of TM from gastric cancer have been described in the literature and they are generally of Asian origin. This data was recently confirmed by Chund et al. [7], the most common sites of the primary tumors that metastasize to the thyroid gland are renal cell (48%), colorectal (10%), lung (8%), breast carcinoma (8%) and sarcoma (4%). Only one case of TM from gastric cardia cancer has been reported.
The initial presentation can be a multinodular goiter, thyroid nodule or an enlarged thyroid mass [4]. Sometimes patients were asymptomatic and the thyroid disease was found fortuitously. Rare cases presented compression symptoms such as dyspnea, dysphonia or dysphagia [5].
Usually thyroid functions remains normal, although hypothyroidism and hyperthyroidism have been reported. The ultrasound finding of thyroid metastasis is nonspecific and it remains difficult to distinguish between primary and metastatic tumor [7].
Fine needle aspiration (FNA) cytology, when performed, identifies malignant tumors in 90% of cases but the diagnosis for secondary malignancy only ranges from 45% to 60% [2]. One major difficulty in cytological interpretation is to distinguish between primary thyroid anaplastic carcinoma and metastatic high grade malignancy. Numerous studies have suggested that metastases to the thyroid gland are associated with poor prognosis [6]. In fact, the prognosis is variable and basically depends on the primary cancer and the isolated nature of the TM [4]. There is no clear consensus for the treatment of TM. Previous studies have recommended a thyroid lobectomy if there is a solitary thyroid metastasis and a total thyroidectomy for bilateral metastasis [6]. The majority of authors agree that in cases of multiple metastases, thyroid surgery should only be performed in patients presenting signs of tracheal compression [4]. Surgical treatment of solitary thyroid metastases is recommend because patients affected by a single thyroid metastasis have a good prognosis. Oppositely, patients with disseminated disease have a poor prognosis, and surgical treatment of these patients is indicated as a life-saving measure or for the palliation of significant compressive symptoms. Chemotherapy and targeted therapies can be used and depend on primary cancer. Radiotherapy can be a useful tool to decrease the tumor volume. Ligasure vessel could be a benefit tool in these hemorragic cases as reported in recent paper [8].

Conclusion

Metastases to the thyroid gland are rare but should always be suspected in any patient with a previous history of malignancy. They usually occur when there are metastases elsewhere in the body, sometimes many years after diagnosis of the original primary tumor. Although detection of metastasis to the thyroid gland often indicates poor prognosis, surgical resection of an isolated metastasis can result in prolonged disease-free survival.

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