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Thyroid Nodule

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Thyroid Nodule Thyroid Nodule Presentation Transcript

  • An interesting thyroid nodule Dr Nidhi Bhatt St Georges Hospital May 2006
  • Case History
    • 66 y, male
    • Multinodular goitre- two nodules felt
    • Long standing, painless
    • No other history provided
    • FNA
      • Cellular follicular lesion
      • Excision advised
  • Macroscopic specimen
    • Lobectomy specimen 78g and 80x50x35 mm
    • Lobulated surface
    • Multiple nodules on C/S-
      • Well-circumscribed
      • Encapsulated
      • Cream-coloured homogenous
      • Occ. foci of haemorrhage
  • Dilated thin- walled central blood vessels Closely packed nests of clear cells
  • Adjacent normal thyroid follicles Encapsulation
  • Clear cytoplasm, angulated nuclei, mild nuclear pleomorphism Fibrovascular stroma with delicate septa
  • Differential Diagnoses Clear cell change in 1 º thyroid tumours Parathyroid neoplasms Metastatic renal clear cell carcinoma
  • Further steps Clinical correlation Histochemical stains Immunostains
  • Special stains
    • PAS +/- diastase
    • Thyroglobulin
    • TTF-1
    • CAM
    • CK7/20
    • Vimentin
    • CD10
    • Calcitonin
  • TTF -Ve
  • CD10 +ve
  • Vimentin +ve
  • Other results
    • Cytoplasmic PAS-positive globules
    • CK7/ 20 -ve
    • CAM 5.2 +ve
    • Thyroglobulin -ve
    • Calcitonin -ve
    • Neuroendocrine markers -ve
  • Metastatic clear cell renal carcinoma
  • Case discussed at the head & neck MDT Renal tumour removed 25 years ago in 1984, diagnosed as Clear cell carcinoma , G2, pT2
  • Further Ix
    • No metastases in other organs
    • No lymph nodes
    • Other kidney normal
  • Discussion
    • Intrathyroidal mets do occur
      • 0.6-1.2 % in thyroidectomies
      • 0.5-24% at autopsy
    • Most common primary sites
      • Lung (16-43%)
      • Kidney (5.5-33%)
      • Breast (1-16%)
      • Stomach (8%)
      • Uterus (7%)
  • Contd…
    • Average interval
      • 0-19 years
      • 25 years in the present case
    • Prognosis depends on
      • Primary site
      • Completeness of resection
    • Rx
      • Thyroidectomy to avoid morbidity of tumour recurrence in neck
  • Moral of the story New thyroid mass in a patient with previous history of malignancy Think of metastatic deposits
  • When in doubt, take the case to MDM !
  • References
    • Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatis disease to the thyroid gland. World J Surg 1999;23(2):177-80
    • Dequanter D, Lothaire P, Larsimont D etal. Intrathyroid metastasis:11 cases Ann Endocrinol (Paris) 2004;65(3):205-8
    • Lam KY, Lo CY. Metastatic tumours of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med 1998;122(1):37-41
    • Nakhjavani MK, Gharib H, Goelner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer 1997;79(3):574-8