Cancer metastasis to the thyroid gland is a very rare phenomenon. Tumors that lead to secondary involvement of the thyroid include malignant neoplasms of the kidney, breast, colorectal, lung and head/neck region. Metastasis from uterine cancer constitutes about 1.3-4% of all the malignancies affecting the thyroid gland.
We are reporting a case of thyroid metastasis from a uterine papillary serous carcinoma in a 71-year-old woman, who presented to us with goiter and dysphagia.
Methods : .
Results : Our patient is a 71-year-old female with a medical history significant for remote breast cancer-status post bilateral mastectomy in 1998 and uterine papillary serous carcinoma (Grade-1 UPSC)- status post chemotherapy, vaginal brachytherapy and total abdominal hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic node dissection, omentectomy, and retroperitoneal space dissection 4 years prior to presentation. She complained of dysphagia and neck swelling for about six months. On examination, she had a multinodular goiter that moved upwards with swallowing. On thyroid ultrasound, the right thyroid lobe measured 4.7 x 1.9 x 1.8 cm and the left thyroid lobe 6.1 x 1.8 x 1.7 cm. Multiple hypoechoic solid-appearing nodules were noted within the thyroid gland bilaterally. Labs showed TSH of 1.46 (Normal 0.5-6 uU/ml), free T3 of 2.68 (Normal 2.4- 4.2 pg/mL) and free T4 of 1.19 (Normal 0.8-1.8 ng/dL). A fine needle biopsy was performed and histopathology showed neoplastic cells with no colloid in the background. A diagnosis of metastatic uterine papillary serous cancer was made and the patient underwent radiotherapy with significant relief of symptoms
Discussion : Malignancies of the thyroid gland - both primary and secondary are a rare diagnosis. Primary thyroid cancer comprises 1% of all cancers in the United States. To our knowledge, this is the first case report of uterine papillary serous carcinoma metastasizing to the thyroid gland.
Conclusion : Local and distant metastases are a major problem with uterine cancer even after surgical intervention. Although the thyroid is not a commonly involved, it is important to maintain a high index of suspicion for this association in a patient with a history of uterine cancer presenting with dysphagia, goiter and/or hoarseness of voice.
Syeda Naqvi– Physician, Presence health, Chicago, Illinois
Thomas Varghese– Resident Physician, Saint Joseph Hospital Chicago, chicago, Illinois
Faisal Qureshi– Chief Section of Endocrinology, Presence Saint Joseph Hospital Chicago, chicago
faisal qureshi– Chief Section of Endocrinology, Presence Saint Joseph Hospital Chicago, chicago
Currently working as a first year resident at Presence Saint Joseph Hospital. Interested in the field of Endocrinology
Saint Joseph Hospital Chicago
I am currently a third year resident in internal medicine at Chicago interested in Endocrinology and Oncology.
Chief Section of Endocrinology
Presence Saint Joseph Hospital Chicago