J Korean Med Sci.  2014 Jun;29(6):818-824. 10.3346/jkms.2014.29.6.818.

Diffuse Metastasis to the Thyroid: Unique Ultrasonographic Finding and Clinical Correlation

• Kim HK
• Kim SS
• Oak CY
• Kim SJ
• Yoon JH
• Kang HC

• KMID: 1796945
• DOI: http://doi.org/10.3346/jkms.2014.29.6.818

Abstract

Cases of metastases to the thyroid gland seem to be increasing in recent years. The clinical and ultrasonographic findings of diffuse metastases have been sparsely reported. Thirteen cases of diffuse metastases to the thyroid gland were documented by thyroid ultrasonography-guided fine needle aspiration cytology between 2004 and 2013. We retrospectively reviewed the patients with diffuse thyroid metastases. The most common primary site was the lung (n=9), followed by unknown origin cancers (n=2), cholangiocarcinoma (n=1), and penile cancer (n=1). Eleven patients were incidentally found to have thyroid metastases via surveillance or staging FDG-PET. Other 2 patients were diagnosed during work-up for hypothyroidism and palpable cervical lymph nodes. On ultrasonography, the echogenicity of the enlarged thyroid gland was heterogeneously hypoechoic or isoechoic, and reticular pattern internal hypoechoic lines were observed without increased vascularity found by power Doppler ultrasonography (3 right lobe, 2 left lobe, and 8 both lobes). In the 8 patients who had involvement of both lobes, 3 had hypothyroidism. In conclusion, ultrasonographic finding of diffuse metastasis is a diffusely enlarged heterogeneous thyroid with reticular pattern internal hypoechoic lines. Thyroid function testing should be performed in all patients with diffuse thyroid metastases, especially those with bilateral lobe involvement.

Keyword

Thyroid; Diffuse; Metastasis; Ultrasonography; Fine Needle Aspiration Cytology

MeSH Terms

Aged
Bile Duct Neoplasms/pathology
Biopsy, Fine-Needle
Cholangiocarcinoma/pathology
Female
Fluorodeoxyglucose F18/diagnostic use
Humans
Hypothyroidism/complications
Lung Neoplasms/pathology
Male
Middle Aged
Penile Neoplasms/pathology
Positron-Emission Tomography
Radiopharmaceuticals/diagnostic use
Thyroid Function Tests
Thyroid Gland/pathology/*ultrasonography
Thyroid Neoplasms/pathology/secondary/*ultrasonography
Fluorodeoxyglucose F18
Radiopharmaceuticals

Figure

• 

  Fig. 1 Ultrasonographic findings of diffuse metastases to the thyroid. (A, B) 65-yr-old man with thyroid metastasis arising from penile squamous cell carcinoma. Transverse sonogram (A) shows diffuse thyroid enlargement with irregular hypoechoic striae (white arrow). Power Doppler study (B) documents no vascularity in the enlarged thyroid and hypoechoic lines. Longitudinal sonograms of 65-yr-old man with metastatic lung squamous cell carcinoma (C) and 68-yr-old man with unknown origin adenocarcinoma (D) show similar imaging features.

• 

  Fig. 2 The histology shows the primary foci and cytological features of matched thyroid lesions (A-C, Case 2; D-F, Case 11; G-I, Case 13). (A) Tumor nests of a well-differentiated squamous cell carcinoma are observed in a specimen of right bronchus. (B, C) Thyroid cytology of Case 2 reveals a slight inflammatory background, and two populations of epithelial cells: follicular epithelial cells and tumor cells. Dyskeratotic cells are also observed in the tumor clusters. (D) A moderately differentiated adenocarcinoma is seen, with frequent mitotic figures. (E, F) The cytology of Case 11 shows a colloid background and heterogeneous population. (G) A poorly differentiated adenocarcinoma is seen. (H, I) Smear of the thyroid aspirate shows large hyperchromatic atypical cells with occasional intracytoplasmic vacuoles. (A, D, G, hematoxylin and eosin, ×400; B, C, E, F, H, I, Papanicolaou stain, ×400).

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