J Korean Soc Radiol.  2015 Mar;72(3):198-201. 10.3348/jksr.2015.72.3.198.

Ultrasonography Findings of Thyroid Metastasis in a Patient with Hepatocellular Carcinoma: A Case Report

• Kim KH
• Park NH
• Lim JH
• Park CS
• Seong SO
• Kwon TJ

• KMID: 2161174
• DOI: http://doi.org/10.3348/jksr.2015.72.3.198

Abstract

Although the thyroid gland is one of the most vascular organs of the body, metastatic disease in the thyroid is encountered infrequently. However, at autopsy, the incidence rate of thyroid metastasis ranges from 1.25% to 24%. The primary sites are the kidney, lung, breast, and gastrointestinal tract. We report a rare case of a hepatocellular carcinoma metastatic to the thyroid gland. The patient had multiple palpable masses in the anterior and left lateral neck along the internal jugular chain on physical examination 9 months after the initial diagnosis of liver tumor. These masses were confirmed as metastasis from hepatocellular carcinoma by ultrasonography-guided 16-G core needle biopsy. We discuss the sonographic findings of thyroid metastasis and their use as an additional aid for differentiating between unknown primary tumor and thyroid metastasis.

MeSH Terms

Autopsy
Biopsy, Large-Core Needle
Breast
Carcinoma, Hepatocellular*
Diagnosis
Gastrointestinal Tract
Humans
Incidence
Kidney
Liver
Lung
Neck
Neoplasm Metastasis*
Neoplasms, Unknown Primary
Physical Examination
Thyroid Gland*
Ultrasonography*

Figure

• 

  Fig. 1 Hepatocellular carcinoma with thyroid metastasis in a 53-year-old male patient. A. Initial CT taken 3 yrs ago. A low density hepatic mass 3.8 × 3.5 cm in size was noted in segment 7 of the liver. This mass was regarded as a liver abscess. B, C. Follow-up CT scans. A 8.4 × 2 cm elongated mass was noted in the right hepatic lobe with invasion of right hepatic vein showing arterial enhancement and delayed washout pattern of enhancement. The findings were highly of hepatocellular carcinoma. Tumor thrombosis of right hepatic vein and intrahepatic segment of inferior vena cava were evident. D. A 4 cm sized homogenous hypoechoic solid mass replaced the left thyroid lobe. The masses in the thyroid gland showed heterogenous hypoechoic features without necrosis or calcification. E, F. Enlarged pathologic lymph nodes, left level 3 and 4 were evident. The nodes showed the same nature as the thyroid masses. No significant increase of intratumoral or intranodal vascularity was found on color Doppler study-denotes metastatic lymph nodes. G. Typical trabecular pattern of tumor cells (hematoxylin & eosin stain, × 100). H. Higher magnification of tumor cells showing pleomorphic cells with nuclear atypia (hematoxylin & eosin stain, × 200).

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