J Korean Med Sci.  2014 Oct;29(10):1432-1435. 10.3346/jkms.2014.29.10.1432.

Metastasis of Colon Cancer to Medullary Thyroid Carcinoma: A Case Report

• Yeo SJ
• Kim KJ
• Kim BY
• Jung CH
• Lee SW
• Kwak JJ
• Kim CH
• Kang SK
• Mok JO

• KMID: 2129636
• DOI: http://doi.org/10.3346/jkms.2014.29.10.1432

Abstract

Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.

Keyword

Colorectal Neoplasms; Thyroid Neoplasms; Neoplasm Metastasis

MeSH Terms

Adenocarcinoma/pathology/surgery
Biopsy, Fine-Needle
Carcinoma, Medullary/diagnosis/radiography/*secondary
Colonic Neoplasms/*pathology/surgery
Humans
Male
Middle Aged
Neoplasms, Second Primary/*diagnosis
Thyroid Gland/pathology
Thyroid Neoplasms/diagnosis/radiography/*secondary
Thyroid Nodule/diagnosis

Figure

• 

  Fig. 1 PET scan and Ultrasound finding. (A) PET scan shows focal hypermetabolism in the right lobe of thyroid gland (SUV 2.5). (B) Ultrasonography shows marked hypoechoic solid nodule with lobulated margin with inner microcalcification, measured 1.6×1.0×2.5 cm (2.42 cm3), in right mid pole.

• 

  Fig. 2 Histopathologic and immunohistochemical staining findings of thyroid lesion. (A) Gross findings reveal a well circumscribed round gray-tan nodular mass with an ill defined white solid portion and central irregular yellow necrosis (arrow). (B) Microscopic findings show a medullary carcinoma which is composed of nests or sheets of round or spindle tumor cells and acellular eosinophilic stroma (center), and colonic adenocarcinoma with glandular differentiation (right) in the normal thyroid parenchyme (left), (H&E stain, ×40). (C) Immunohistochemical staining for chromogranin A reveals positive staining in medullary carcinoma (brown) and negative staining in colonic adenocarcinoma (×40). (D) Immunohistochemical staining for calcitonin shows diffuse strong cytoplasmic positivity (brown) in the tumor cell of medullary component (×100). (E) Immunohistochemical staining for CDX2 shows a strong positive nuclear staining (brown) in colonic adenocarcinoma (×200).

Reference

1. Baloch ZW, LiVolsi VA. Tumor-to-tumor metastasis to follicular variant of papillary carcinoma of thyroid. Arch Pathol Lab Med. 1999; 123:703–706.

2. Cherk MH, Moore M, Serpell J, Swain S, Topliss DJ. Metastatic colorectal cancer to a primary thyroid cancer. World J Surg Oncol. 2008; 6:122.

3. Rosai J, Carcangiu ML, DeLellis RA. 3rd series, Fascicle 5. Atlas of Tumor Pathology: tumors of the thyroid gland. Washington, DC: Armed Forces Institute of Pathology;1992.

4. Witt RL. Colonic adenocarcinoma metastatic to thyroid Hürthle cell carcinoma presenting with airway obstruction. Del Med J. 2003; 75:285–288.

5. Hashimoto K, Yamamoto H, Nakano T, Oyama M, Shiratsuchi H, Nakashima T, Tamiya S, Komune S, Oda Y. Tumor-to-tumor metastasis: lung adenocarcinoma metastasizing to a follicular variant of papillary thyroid carcinoma. Pathol Int. 2011; 61:435–441.

6. Mori K, Kitazawa R, Kondo T, Kitazawa S. Lung adenocarcinoma with micropapillary component presenting with metastatic scrotum tumor and cancer-to-cancer metastasis: a case report. Cases J. 2008; 1:162.

7. Bohn OL, De las Casas LE, Leon ME. Tumor-to-tumor metastasis: renal cell carcinoma metastatic to papillary carcinoma of thyroid-report of a case and review of the literature. Head Neck Pathol. 2009; 3:327–330.

8. Ryska A, Cáp J. Tumor-to-tumor metastasis of renal cell carcinoma into oncocytic carcinoma of the thyroid. Report of a case and review of the literature. Pathol Res Pract. 2003; 199:101–106.

9. Yu J, Nikiforova MN, Hodak SP, Yim JH, Cai G, Walls A, Nikiforov YE, Seethala RR. Tumor-to-tumor metastases to follicular variant of papillary thyroid carcinoma: histologic, immunohistochemical, and molecular studies of two unusual cases. Endocr Pathol. 2009; 20:235–242.

10. Terzi A, Altundag K, Saglam A, Gurlek A, Aksoy S, Baltali E, Uner AH. Isolated metastasis of malignant melanoma into follicular carcinoma of the thyroid gland. J Endocrinol Invest. 2004; 27:967–968.

11. Matsukuma S, Kono T, Takeo H, Hamakawa Y, Sato K. Tumor-to-tumor metastasis from lung cancer: a clinicopathological postmortem study. Virchows Arch. 2013; 463:525–534.

12. Berent W. Seltene metastsenbildung. Zentralbl Allg Pathol Int. 1902; 13:406–410.

13. Campbell LV Jr, Gilbert E, Chamberlain CR Jr, Watne AL. Metastases of cancer to cancer. Cancer. 1968; 22:635–643.

14. Moghaddam PA, Cornejo KM, Khan A. Metastatic carcinoma to the thyroid gland: a single institution 20-year experience and review of the literature. Endocr Pathol. 2013; 24:116–124.

15. Papi G, Fadda G, Corsello SM, Corrado S, Rossi ED, Radighieri E, Miraglia A, Carani C, Pontecorvi A. Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin Endocrinol (Oxf). 2007; 66:565–571.

16. Calzolari F, Sartori PV, Talarico C, Parmeggiani D, Beretta E, Pezzullo L, Bovo G, Sperlongano P, Monacelli M, Lucchini R, et al. Surgical treatment of intrathyroid metastases: preliminary results of a multicentric study. Anticancer Res. 2008; 28:2885–2888.

17. Cichoń S, Anielski R, Konturek A, Barczyński M, Cichoń W. Metastases to the thyroid gland: seventeen cases operated on in a single clinical center. Langenbecks Arch Surg. 2006; 391:581–587.

18. Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade. Thyroid. 2012; 22:258–268.

19. Willis RA. Metastatic tumours in the thyreoid gland. Am J Pathol. 1931; 7:187–208.

20. Stevens TM, Richards AT, Bewtra C, Sharma P. Tumors metastatic to thyroid neoplasms: a case report and review of the literature. Patholog Res Int. 2011; 2011:238693.