Ann Rehabil Med.  2012 Oct;36(5):735-738.

Thyroid Cancer Initially Presenting Compression Fracture without Common Thyroid Symptoms

• Kim DH
• Yoo SD
• Kim SM
• Im SJ
• Kang JK
• Cho EH

Abstract

Thyroid carcinoma is the commonest endocrinological malignancy. After papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) is the second most common histological subtype. Common presentations of FTC include a solitary thyroid nodule and cervical lymphadenopathy. The incidence of individuals diagnosed with thyroid cancer showing initially distant metastatic disease ranges from 1 to 9%. Also, the incidence of solitary bone metastasis from thyroid is only 2 to 3%. We report a case of a patient with FTC whose initial presentation was low back pain and right buttock pain due to vertebral metastasis rather than the usual neck lumps or symptoms of thyroid disease.

Keyword

Follicular thyroid carcinoma; Spinal metastasis; Compression fracture

MeSH Terms

Adenocarcinoma, Follicular
Buttocks
Carcinoma
Fractures, Compression
Humans
Incidence
Low Back Pain
Lymphatic Diseases
Neck
Neoplasm Metastasis
Thyroid Diseases
Thyroid Gland
Thyroid Neoplasms
Thyroid Nodule
Carcinoma
Thyroid Neoplasms

Figure

• 

  Fig. 1 X-ray showed only L4 compression fracture, with preservation of the pedicles (arrow). (A) Anterior-posterior view. (B) Lateral view.

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  Fig. 2 MRI had appearances suggestive of an infectious spondylitis such as TB spondylitis associated with a pathologic fracture rather than a metastatic bone tumor (arrow), because vertebral involvement by metastasis may occur without collapse or subligamentous spread and disks are usually preserved. (A) T2 Axial view. (B) T2 Sagittal view.

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  Fig. 3 (A) Frozen biopsy: The upper part of figure is tumor and the lower part is bone. Histologically, the mass in the vertebral body demonstrated well-differentiated follicles containing colloid invading the surrounding trabecular bone (H&E stain, ×40). (B) Immunochemistry staining: Positive immunoreactivity for the existence of proteins of thyroid origin (TTF-1) (H&E stain, ×40). (C) PET showed mildly increased FDG uptake in both thyroid glands (arrow).

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