Metastatic Thyroid Osteosarcoma With Concomitant Multifocal Papillary Carcinoma Presenting as a Collision Tumor

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Abstract

Metastatic involvement of the thyroid occurs rarely, by either hematogenous spread or direct extension from adjacent organs. The most frequent metastatic tumors are clear cell, renal cell, lung, breast, and squamous cell carcinoma.

The occurrence of osteosarcoma and papillary thyroid carcinoma in the same patient is rare, with only a few reported cases in the literature. On the other hand, only one case of osteosarcoma thyroid metastasis has so far been reported.

We herewith present another case with metastatic osteosarcoma and multifocal papillary thyroid carcinoma presenting as a collision tumor and review the relevant literature.

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Most cited references 18

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Metastases to the thyroid: a review of the literature from the last decade.

R Weisman, Kevin T. Brumund, Michael Bouvet … (2012)

Although clinically evident metastases of nonthyroid malignancies (NTMs) to the thyroid gland are uncommon, it is important to suspect them in patients who present with a new thyroid mass and a history, however far back, of prior malignancy. In fact, metastases from NTMs to the thyroid gland have been reported in 1.4%-3% of all patients who have surgery for suspected cancer in the thyroid gland. Here we review the literature over the last decade regarding this topic. Based on recent literature, the most common NTMs that metastasize to the thyroid gland are renal cell (48.1%), colorectal (10.4%), lung (8.3%), and breast carcinoma (7.8%), and sarcoma (4.0%). Metastases of NTMs to the thyroid are more common in women than men (female to male ratio=1.4 to 1) and in nodular thyroid glands (44.2%). The mean and median intervals between diagnosing NTMs and their metastases to thyroid gland are 69.9 and 53 months, respectively. In 20% of cases the diagnosis of the NTM and its metastases to the thyroid was synchronous. Recent reports indicate that there is a higher frequency of sarcoma metastasizing to the thyroid gland than reported in prior years. Fine-needle aspiration biopsy (FNAB) of thyroid masses is useful in diagnosis of thyroid metastases. However, this requires information about the NTM so that the proper antibodies can be used for immunohistochemical analysis; therefore it is of lesser utility if the NTM is occult. In patients with preexisting thyroid pathology the FNAB diagnosis can be more difficult due to more than one lesion being present. It is important to keep in mind that the thyroid gland can be a site of metastases for a variety of tumors when evaluating a thyroid nodule, especially in a patient with a prior history of malignancy. In patients with thyroid lesions and a history of malignant disease, regardless of time elapsed since the initial diagnosis of the primary neoplasm, disease recurrence or progression of malignancy must be considered until proven otherwise.

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Metastasis to the thyroid gland. A report of 43 cases.

Odile van den Heuvel, Walid H. Gharib, J Goellner … (1997)

The incidence of metastasis to the thyroid gland in autopsy series varies from 1.25% to 24%. Metastasis to the thyroid gland is usually considered a terminal event, and the effectiveness of conventional treatment has been questioned. The authors assessed the effects of current methods of diagnosis and treatment on the course of the disease. Forty-three patients with metastasis to the thyroid gland were studied retrospectively. Primary tumor origin was identified in all but two cases. Metastasis to the thyroid gland was confirmed by fine-needle aspiration cytology or histology. Data were analyzed for the frequency and types of malignant lesions, the clinical course of disease, and the prognosis after thyroid involvement. The kidney was the most common primary tumor site (33%), followed by lung (16%), breast (16%), esophagus (9%), and uterus (7%). The time from diagnosis of the primary tumor to metastasis to the thyroid gland was considerable for renal cell adenocarcinoma (mean, 106 months) and for adenocarcinomas of the breast (mean, 131 months) and uterus (mean, 132 months). In 12 patients, this interval was more than 120 months. Fine-needle aspiration cytology detected metastatic malignancy in 29 of 30 patients. Treatment involved surgery alone, surgery with adjuvant therapy, or nonsurgical methods. Two patients with uterine adenocarcinoma and one with breast adenocarcinoma had disease regression with no evidence of tumor recurrence. In any patient with a previous history of malignancy, no matter how remote that history is, a new thyroid mass should be considered recurrent malignancy until proved otherwise. Although detection of metastasis to the thyroid gland often indicates poor prognosis, aggressive surgical and medical therapy may be effective in a small percentage of patients.

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Metastasis to the Thyroid Gland: A Critical Review

Iain Nixon, Andrés Coca-Pelaz, Anna I. Kaleva … (2016)

Background Metastasis to the thyroid gland from nonthyroid sites is an uncommon clinical presentation in surgical practice. The aim of this review was to assess its incidence management and outcomes. Methods A literature review was performed to identify reports of metastases to the thyroid gland. Both clinical and autopsy series were included. Results Metastases to the gland may be discovered at the time of diagnosis of the primary tumor, after preoperative investigation of a neck mass, or on histologic examination of a thyroidectomy specimen. The most common primary tumors in autopsy studies are from the lung. In clinical series, renal cell carcinoma is most common. For patients with widespread metastases in the setting of an aggressive malignancy, surgery is rarely indicated. However, when patients present with an isolated metastasis diagnosed during follow-up of indolent disease, surgery may achieve control of the central neck and even long-term cure. Other prognosticators include features of the primary tumor, time interval between initial diagnosis and metastasis, and extrathyroid extent of disease. Conclusions In patients with thyroid metastases, communication among clinicians treating the thyroid and the index primary tumor is essential. The setting is complex, and decisions must be made considering the features of the primary tumor, overall burden of metastases, and comorbidities. Careful balancing of these factors influences individualized approaches.

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Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 3 June 2021

Publication date (Electronic, collection): June 2021

Volume: 13

Issue: 6

Electronic Location Identifier: e15425

Affiliations

[1 ] 2nd Department of Pathology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, GRC

[2 ] 2nd Department of Ear, Nose, Throat (ENT), National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, GRC

[3 ] Department of Thoracic Surgery, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, GRC

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Nektarios Koufopoulos koufonektar@ 123456yahoo.com

Article

DOI: 10.7759/cureus.15425

PMC ID: 8259070

PubMed ID: 34262800

SO-VID: 74019999-34b3-49c9-8698-1b7391f2db53

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This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Metastatic Thyroid Osteosarcoma With Concomitant Multifocal Papillary Carcinoma Presenting as a Collision Tumor

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Most cited references 18

Metastases to the thyroid: a review of the literature from the last decade.

Metastasis to the thyroid gland. A report of 43 cases.

Metastasis to the Thyroid Gland: A Critical Review

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