Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
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A Case of Skin Metastasis from Papillary Thyroid Carcinoma

유두상 갑상선암의 피부전이 1예

  • Lim Chi-Young (Department of Surgery, Yonsei University College of Medicine) ;
  • Lee Jan-Dee (Department of Surgery, Yonsei University College of Medicine) ;
  • Nam Kee-Hyun (Department of Surgery, Yonsei University College of Medicine) ;
  • Kwhan Ji-Eun (Department of Pathology, Yonsei University College of Medicine) ;
  • Chang Hang-Seok (Department of Surgery, Yonsei University College of Medicine) ;
  • Chung Woong-Yoon (Department of Surgery, Yonsei University College of Medicine) ;
  • Park Cheong-Soo (Department of Surgery, Yonsei University College of Medicine)
  • 임치영 (연세대학교 의과대학 외과학교실) ;
  • 이잔디 (연세대학교 의과대학 외과학교실) ;
  • 남기현 (연세대학교 의과대학 외과학교실) ;
  • 권지은 (연세대학교 의과대학 병리학교실) ;
  • 장항석 (연세대학교 의과대학 외과학교실) ;
  • 정웅윤 (연세대학교 의과대학 외과학교실) ;
  • 박정수 (연세대학교 의과대학 외과학교실)
  • Published : 2005.11.01
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Abstract

Skin metastasis from papillary thyroid carcinoma is extremely rare. Due to similar histopathologic features, it is difficult to differentiate skin metastatic papillary thyroid carcinoma and some primary skin neoplasms without a clinical history. However, most of metastatic skin lesions showed a strong reactivity to the antithyroglobulin antibodies unlike primary skin neoplasms. Metastatic skin lesions must be completely removed and radiotherapy can be added. Investigators reported that prognosis of skin metastases from thyroid carcinoma is dismal and the average survival after it's diagnosis was only 19 months because distant metastases were often discovered at diagnosis of skin metastasis or during follow-up period. We report a case of skin metastasis from tall cell variant of papillary thyroid carcinoma. In our case, the anti thyroglobulin antibodies measured from cystic fluid from a skin lesion was more than 2000 IU/ml. Skin metastasis was diagnosed at 20 months after primary surgery for thyroid cancer and brain metastasis at 12 months after diagnosis of skin metastasis. Although skin metastasis is an ominous prognostic indicator in patients with thyroid carcinoma, a radical treatment for skin lesions and early diagnosis of distant metastasis could provide a chance to the patients to improve their survival.

Keywords

References

  1. Rosario PW, Fagundes TA, Padrao EL, Rezende LL, Barroso AL: Total thyroidectomy and lymph node dissection in patients with papillary thyroid carcinoma. Arch Surg. 2004;139 (4): 390-394 https://doi.org/10.1001/archsurg.139.4.390
  2. Dinneen SF, Valimaki MJ, Bergstralh EJ, et al: Distant metastases in pillary thyroid carcinoma: 100 cases observed at one institution during 5 decades. J Clin Endocrinol Metab. 1995;80: 2041-2045 https://doi.org/10.1210/jc.80.7.2041
  3. Schlumberger M, Tubiana M., De Vathaire F, et al: Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma. J Clin Endocrinol Metab. 1986;63:960-967 https://doi.org/10.1210/jcem-63-4-960
  4. Mizukami Y, Michigishi T, Nomomura A, et al: Distant metastases in differentiated thyroid carcinomas: a clinical and pathologic study. 1990;20:283-290
  5. Samaan NA, Schultz PN, Hickey RC, et al: The results of various modalities of treatment of well differentiated thyroid carcinoma; a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75:714-720 https://doi.org/10.1210/jc.75.3.714
  6. Hoie J, Stenwig AE, Kullmann G, Lindergaard M, et al: Distant metastases in papillary thyroid cancer. A review of 91 patients. Cancer. 1988;61:1-6 https://doi.org/10.1002/1097-0142(19880101)61:1<1::AID-CNCR2820610102>3.0.CO;2-R
  7. Brownstein MH, Helwig EB: Metastatic tumors to the skin. Cancer. 1977;29:128-130
  8. Dahl PR, Brodland DG, Goellner JR: Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol. 1997;36:531-537 https://doi.org/10.1016/S0190-9622(97)70239-1
  9. Koller BA, Tourtelot JB, Pak HS: Papillary and follicular thyroid carcinoma metastatic to the skin: a case report and review of the literature. Thyroid. 1998;8:1045-1050 https://doi.org/10.1089/thy.1998.8.1045
  10. Elgart GW, Patterson JW, Taylor R: Cutaneous metastasis from papillary carcinoma of the thyroid gland. Journal of the American Academy of Dermatology. 1991;25:404-408 https://doi.org/10.1016/0190-9622(91)70216-O
  11. Ruter A, Nishiyama R, Lennquist S: Tall-cell variant of papillary thyroid cancer: disregarded entity? World J Surg 1997;21:15-20 https://doi.org/10.1007/s002689900187
  12. Filie AC, Chiesa A, Bryant BR, Merino MJ, Sobel ME, Abati A: The Tall-cell variant of papillary carcinoma of the thyroid: cytologic features and loss of heterozygosity of metastatic and/or recurrent neoplasms and primary neoplasms. Cancer. 1999;87: 238-242 https://doi.org/10.1002/(SICI)1097-0142(19990825)87:4<238::AID-CNCR12>3.0.CO;2-N
  13. Ostrowski ML, Merino MJ: Tall cell variant of papillary thyroid carcinoma: A reassessment and immunohistochemical study with comparison to the usual type of papillary carcinoma of the thyroid. Am J Surg Pathol. 1996;20:964-974 https://doi.org/10.1097/00000478-199608000-00005
  14. Woodworth H Jr, Dockerty MB, Wilson RB, et al: Papillary hidradenoma of the vulva:a clincopathologic study of 69 cases. Am J Obstet Gynecol. 1971;110:501-508 https://doi.org/10.1016/0002-9378(71)90691-0
  15. Meeker JH, Neubecker RD, Helwig EB: Hiradenoma papilliferum. Am J Clin Pathol. 1962;37:182-195 https://doi.org/10.1093/ajcp/37.2.182
  16. Helwig EB, Hackney VC: Syringadenoma papilliferum. Arch/dermatol. 1955;71:361-372 https://doi.org/10.1001/archderm.1955.01540270073011
  17. Bocker W, Dralle H, Husselmann H, Bay V, Brassow M: Immunohistochemical analysis of thyroglobulin synthesis in thyroid carcinomas. Virchows Arch A Pathol Anat Histol. 1980;385:187-200 https://doi.org/10.1007/BF00427404
  18. Albores-Saavedra J, Nadji M, Civantos F, Morales AZ: Thyroglobulin in carcinoma of the yroid. Hum Pathol 1983;14:62-66 https://doi.org/10.1016/S0046-8177(83)80046-X
  19. Kawaoi A, Okano T, Nemoto: Simultaneous detection of thyroglobulin (Tg), thyroxine (T4), and triiodthyronine (T3) in nontoxic thyroid tumors by the immunoperoxidase method. Am J Pathol. 1982;108;39-49
  20. Rico MJ, Penneys NS: Metastatic follicular carcinoma of the thyroid to the skin: a case confirmed by immunohistochemistry. J Cutan Pathol. 1985;12:103-105 https://doi.org/10.1111/j.1600-0560.1985.tb01609.x