Jamahiriya Medical Journal
Published by the Libyan Board of Medical Specialities
Received 19-01-2010 ; Accepted 24-01-2010 .
Correspondence and reprint request:
Department of Medical Oncology, African Oncology Institute
E-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
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
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 to15years,withamedianof54months.
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
carcinomawas 131 months. headache.ACT 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
brainwas done after that and, was normal showing
www.jmj.org.ly J M J Vo1. 10 No.2 (Summer) 2010Page 154
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
CAand 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 treatmenteligiblepatients.
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. LangenbecksArch Surgery. 2006;
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regularfollowup. malignancy of thyroid and its management. Ann Surg
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Heerden JA. Metastasis to the thyroid gland.A report of
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5- Kim TY, Kim W.B, Gong. G. et al. Metastasis to
thyroid diagnosed by FNAC. Clin. Endocrinology.
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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 thyroidgland.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
Figure 1 Carcinoma of the Breast Metastasising to the
Itrat Mehdi et al Thyroid Metastasis From Breast Cancer
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