Jamahiriya Medical JournalPublished by the Libyan Board of Medical Specialities

Received 19-01-2010 ; Accepted 24-01-2010 .Correspondence and reprint request:Itrat MehdiDepartment of Medical Oncology, African Oncology Institute Sabratha, LibyaE-mail: Itrat -Mehdi@yahoo.com

Thyroid Metastasis from Breast Cancer

Mohd Shafi Moona, Arshad Hussain and Itrat Mehdi.Department of Medical Oncology, African Oncology Institute

Sabratha, Libya

ABSTRACT:

KEY WORDS:

A 45 year Libyan female was diagnosed to have invasive lobular carcinoma of the right breast. Following Surgery and adjuvant treatment she progressed with brain metastasis after 4 years. She developed right lobe thyroid swelling after 5 years. Right thyroid lobectomy was done and histopathology revealed a metastatic carcinoma from the breast. We present this rare unusual case of female breast cancer with brain metastasis, who subsequently developed metastasis to the thyroid gland. Metastasis to thyroid is rare and has rarely been reported. This is the first case reported from this institute.

-Breast cancer, Thyroid metastasis, Sabratha, Unusual metastasis, Rare metastasis.(JMJ 2010,Vol.10, No.2 ,154-155 ).

INTRODUCTION:

CASE REPORT:

Lam and Lo (4) in a study of 79 cases found the incidence Breast cancer usually has a haematogenous spread to the of thyroid secondaries at autopsies was 0.5% and in lung, liver, bone but rarely to the brain. Thyroid thyroidectomy specimens 1.2%. FNAC was positive for metastasis is generally very infrequent, despite the fact malignancy in 80% of cases. The time from diagnosis of that the thyroid gland is a very vascular organ. The primary to thyroid metastasis was 9-36 months. The reported incidences of secondary malignancies from majority of the secondary tumours were carcinomas primary sites are only 3%, and less than 200 cases are (81%.), primaries being lung (43%), followed by the reported in the literature (1-13). Postmortem thyroid breast (9%), stomach (8%), NPC and sarcomas. Kim et metastases at autopsy are encountered in a variable al (5) did retrospective reviews of 22 thyroid metastases percentage (2 -24%) in cancer patients of other primary diagnosed by FNAC. Breast cancer was found to be the tumours (3-4,11). Cicho et al in 2006 (1), reported 17 cases most common primary (five patients), followed by the of metastasis to the thyroid from different primary sites, kidney (three), colon (three) and lung (three). The 13 from renal cell carcinoma, one from breast cancer, interval from the diagnosis of primary tumour to the and another from uterine carcinoma. Total detection of the thyroid metastasis varied from 8 months thyroidectomy was done in all patients. The longest to 15 years, with a median of 54 months.survival time was 11 years. In a 15 year study done by Rosen et al(2), 11 patients were reported with secondary involvement of the thyroid gland , consisting of 3 men A 45 year old unmarried Libyan female presented with a and 8 women with primary lesions occurring in the oral progressive right breast lump. Modified radical cavity, oesophagus, stomach, colon, pancreas, and mastectomy with axillary clearance was done in June breast. Survival was less than 2 years . 2004 and histopathology was invasive lobular carcinoma Forty three patients with metastasis to the thyroid gland (Stage T1N0M0, grade II. ER, PR and HER2/neu were studied retrospectively by Nakhjavani et al (3). The receptors were negative). She did not agree for adjuvant kidney was the most common primary (33%), followed chemotherapy and as tumour size was small was kept on by lung (16%), breast (16%), oesophagus (9%), and regular follow up. She remained disease free for 4 years. uterus (7%). The mean time for metastasis from breast In 2008 the patient presented with the complaint of carcinoma was 131 months. headache. A CT scan of the brain was done showing right

frontal lobe lesion. Excision was done in February 2008 and histopathology was sarcamatoid carcinoma (Fig. 1). The patient received radiotherapy to the brain, 30 Gy in 10 fractions. Bone scan and further work up was done the results were normal. Chemotherapy was started based on Docetaxol and Epirubicin. She received 6 cycles of chemotherapy. CT scan of the chest and abdomen and brain was done after that and, was normal showing

Case Report

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complete resolution of the brain lesion. Mammography previous history of malignancy, no matter how old that of the left breast was normal. Tumour markers (CEA, history is, any new lesions in any morphologic sites CA and 15.3) were normal. In December 2008 the patient should be considered metastasis unless proved presented with a right thyroid lobe swelling. FNAC was otherwise. Although detection of metastasis to the done and was reported as normal. Right lobectomy of thyroid gland often indicates poor prognosis, aggressive the thyroid performed done and histopathology was surgical and medical therapy may prolong the survival in metastatic carcinoma from breast. Second line treatment eligible patients.chemotherapy was started. The slides were reviewed by an independent pathologist outside the institute and confirmed by marker study for IHC panel. Total 1- Cicho S; Anielski R; Konturek A; et al: Metastasis to thyroidectomy was done subsequently and the thyroid gland. Langenbecks Arch Surgery. 2006; histopathology showed no residual tumour. The patient 391(6): 581-587. received second line chemotherapy and is now kept on 2-Rosen IB, Walfish PG, Bain J et al. Secondary regular follow up. malignancy of thyroid and its management. Ann Surg

Oncol, 1995;2:256-6. 3-Nakhjavani M, Gharib H, Goellner JR and von Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer 1997; 79 (3), 574-78, .4-Lam KY, Lo CY. Metastatic tumours of the thyroid gland: a study of 79 cases. Arch Pathol Lab Med.1998;122:37-41.5- Kim TY, Kim W.B, Gong. G. et al. Metastasis to thyroid diagnosed by FNAC. Clin. Endocrinology. 2005; 62(2):236-41.6- Czech JM, Lichtor TR, Carney JA et al. Neoplasms metastatic to thyroid gland. Surg Gynecol Obstet. 1982;155(4): 503-505.7-Schrouder S, Burk CG, de Heer K. Metastasis of thyroid gland. Langenbecks. Arch Chir. 1987; 370(1): 25-35.8-Wood K, Vini, L. Houmer C. Metastasis to thyroid gland. The Royal Marsden Experience. Eur.J. Surg. Oncol, 2004; 30(6): 583-558.9-Geger AS, Shehata SR, Gaude IA. Metastasis to thyroid gland, one out of seven had breast carcinoma. Egypt. J. National Cancer Inst.2006; 18(1), 67-72.10-Mirallie E, Riguad J, Mathonet M, et al . Management

The thyroid is a rare site of metastatic disease from and prognosis of metastases to thyroid gland. J. Am. another primary site (3,4). The commonest primary sites Coll. Surg. 2005; 200 (2): 203-207, for such metastasis to the thyroid gland are renal cell 11- Papi G, Fadda G, Corsello SM et al. Metastases to the carcinoma, lung carcinoma and breast in that order thyroid gland: prevalence, clinic-pathological aspects (1,3,5,7,and 12). Incidence of thyroid metastasis is reported and prognosis: a 10-year experience. Clin from 1.25-24% and usually as terminal event in Endocrinology 2007; 66(4): 565-71.metastatic disease (3). More than 70% cases with thyroid 12-Dequenter D, Lotharia P, Larsimont D et al. metastasis have at least one metastasis before (8). Thyroid Intrathyroid metastasis:11 cases Ann Endocrinol (Paris) metastasis is seen in 0.13% of thyroidectomy specimens 2004;65(3):205-8. 13) Chen H, Nicol TL, Udelsman R. and in 0.07% of FNA specimens worldwide (11). The Clinically significant isolated metastatic disease to usual age of diagnosis is greater than 60 years (11) and thyroid gland.World J. Surg 1999; 23(2): 177-180.median survival is around 10-18 months (12). In 75% of cases there is a solitary thyroid lesion while in 25% there is diffuse thyroid involvement and around 81% are metastatic epithelial tumour (3,4). The time of metastasis to the thyroid gland can range from as early as 8 months to as late as 15 years from initial diagnosis of the primary cancer (5). A total thyroidectomy is the recommended treatment depending on the patient eligibility (1).

The thyroid is a very rare site of metastatic carcinoma from any other primary site. In any patient with a

REFERENCES:

DISCUSSION:

CONCLUSION :

Figure 1 Carcinoma of the Breast Metastasising to the Thyroid Gland.

Itrat Mehdi et al Thyroid Metastasis From Breast Cancer

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