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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
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Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
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The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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Follicular Carcinoma of Thyroid with the First Presentation as Vertebral Column Metastasis: A Case-report

Mazaher Ramezani, Kaivan Mohammadi, Masoud Sadeghi*

Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract: Follicular carcinoma of thyroid is the second most common type of thyroid cancer that its incidence has increased in recent years. Herein, the study reported a 64-year male case of follicular carcinoma of thyroid that his first presentation was vertebral column metastasis. His chief complaint was back pain. In the past medical history, the patient had hypothyroidism and was opium inhalation addict since 15 years ago. Thoraco-lumbar magnetic resonance imaging (MRI) demonstrated spinal tumor of T10. The pathology report showed metastatic follicular carcinoma of thyroid with Thyroid transcription factor-1 (TTF-1), Thyroglobulin (TG), and Cytokeratin-7 (CK-7) positivity. Then thyroidectomy confirmed the diagnosis. In conclusion, follicular carcinoma of thyroid may be presented with spinal column metastasis. Pathologist should consider this diagnosis in the differential diagnosis of metastatic carcinoma in vertebral column and use Thyroglobulin with TTF-1 in immunohistochemistry panel for definite diagnosis and identification of origin.

Keywords: follicular carcinoma, thyroid, metastasis, case report

Citation: Mazaher Ramezani, Kaivan Mohammadi, Masoud Sadeghi, Follicular Carcinoma of Thyroid with the First Presentation as Vertebral Column Metastasis: A Case-report. American Journal of Cancer Prevention, 6 (2). 24-28. January 2018. doi:10.12691/ajcp-6-2-2

1. Introduction

Thyroid cancer in the US accounts for 0.6% of all cancers in men and 1.6% in women [1]. Thyroid cancer initially presents with clinical symptoms due to metastatic lesions in less than 5% of cases. Spinal cord compression from an epidural metastatic lesion as a first symptom is extremely rare [2]. Follicular thyroid carcinoma is the second most common type of thyroid cancer, and its incidence has increased dramatically in recent years [3]. The follicular type tends to typically affect middle-aged females and in 90% of the patients, it presents as a simple thyroid nodule [4]. Out of 2200 differentiated thyroid cancer patients, 394 of whom had lung and/or bone metastasis; of those 394 patients, 201 had metastatic follicular thyroid cancer [5]. The prognosis of metastatic thyroid carcinoma is dependent on the age of the patient, the histologic characteristics of the neoplasm, and the site of metastasis [6]. Presentation with backache, lower limb weakness and perianal numbness is noted and the report is recommended in the literature [7]. This study reported a male case of follicular carcinoma of thyroid that his first presentation was vertebral column metastasis.

2. Case Report

The patient was a 64-year man who presented to the Department of Neurosurgery on 10th October 2016 with the chief complaint of back pain since a few months ago with exacerbation since last month. The pain was aggravated on exercise and in nights. The patient had symptoms of pain and numbness in both lower extremities. There was no the history of weight loss and the pain was alleviated by rest. In the past medical history, the patient had hypothyroidism and was opium inhalation addict since 15 years ago. Drug history was only treatment with levothyroxine. There was no positive familial history of cancer. In the physical examination, upper limb force was 5/5 and of the lower limb was 4/5. There was sensory loss in lower limb, but with no sphincter dysfunction. Thoraco-lumbar magnetic resonance imaging (MRI) demonstrated spinal tumor of T10. The patient underwent surgery on 13th October that the pathologist reported metastatic adenocarcinoma to vertebral column (Figure 1) with recommendation of thyroid, lung and gastrointestinal assessment for the most probable origin. Immunohistochemistry was done on 15th November which showed Thyroid transcription factor-1 (TTF-1), Thyroglobulin (TG) (Figure 2), and Cytokeratin-7 (CK-7) positivity (Figure 3), but Prostatic specific antigen (PSA), Cluster of designation-5 (CD-5), Glial fibrillary acidic protein (GFAP), and CK-20 negativity compatible with metastatic follicular carcinoma of thyroid. The patient underwent total thyroidectomy on 6th February 2017. The specimen was consisted of right and left lobes; and isthmus of thyroid with 3Î3Î1, 3.5Î2Î1 and 1Î0.5 cm in size, respectively. The pathology report showed follicular carcinoma of thyroid with the involvement of both lobes and isthmus with capsular invasion, but no vascular invasion (Figure 4). The greatest size of tumor was 1.5cm. The patient was discharged on 8th February and was in the good condition on 14th February 2017.

Figure 1. Vertebral column metastasis, Hematoxylin-Eosin stain x100 magnification

Figure 2. Thyroglobulin positivity, Immunohistochemical staining x200 magnification

Figure 3. Cytokeratin-7 positivity, Immunohistochemical staining x200 magnification

Figure 4. Follicular carcinoma of thyroid, capsular involvement, Hematoxylin-Eosin stain x40 magnification

3. Discussion

Follicular carcinoma of thyroid originates from follicular cells and resembles the normal microscopic pattern of the thyroid and is usually a well-differentiated tumor [8]. Thyroid cancer is rare and accounts for roughly 1% of all new malignant disease with a male/female ratio of 1/3 [9]. This case presented a case with follicular carcinoma of thyroid and the first presentation as vertebral column metastasis. The follicular type tends to typically affect middle-aged females [4]. The patient’s presenting symptom was bone pain caused by metastatic follicular thyroid cancer in two reports [10,11]. Of all thyroid cancer subtypes, follicular is more likely to present as distant metastases [12] or develop distant metastases during the course of the disease [13].In fact in a pathologic fracture in the vertebral column, metastatic thyroid cancer should be considered in the differential diagnosis along with prostatic and breast origin [14].The pathologist must be familiar with the histopathological characteristics of the follicular thyroid carcinoma [15]. TTF-1 can be used as an immunohistochemistry marker in patients with metastatic bone tumor of unknown origin [11]. Table 1 shows a number of characteristics of patients with metastatic follicular thyroid cancer. Out of seventeen cases, 10 cases (58.8%) were males (male/female ratio: 1/0.7). The mean age of all cases was 53.2 years. Also, back pain was the most common complaint in the patients.

Table 1. The characteristics of metastatic follicular thyroid cancer cases to bone

This tumor may be well encapsulated and demonstrates vascular invasion and spread via vascular channel [22]. In one report correct diagnosis of the tumor with excision of metastases, thyroidectomy and following radioiodine culminated in being symptom free and returning to job in the one -year follow-up [7].

4. Conclusions

Follicular carcinoma of thyroid may be presented with spinal column metastasis. Pathologist should consider this diagnosis in the differential diagnosis of metastatic carcinoma in vertebral column and use Thyroglobulin with TTF-1 in immunohistochemistry panel for definite diagnosis and identification of origin.

References

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