Ear, Nose & Throat Journal2023, Vol. 102(4) 259–262© The Author(s) 2022Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/01455613221145273journals.sagepub.com/home/ear
Papillary thyroid carcinoma is the most common thyroid malignant tumor and usually has a fine prognosis. The most common metastatic site is the cervical lymph node, and distant metastasis is rare. This report describes a female patient with papillary thyroid carcinoma who presented with multiple metastases in the cervical lymph nodes, breast, and spine. The patient’s disease course lasted 11 years, and eventually metastatic cancer led to the patient’s death. We also analyzed the survival rate and median survival time of papillary thyroid carcinoma with multiple organ metastases using data in the literature.
Keywordspapillary thyroid carcinoma, recurrences, metastasis, multiple organ metastasis
Papillary thyroid carcinoma (PTC) accounts for 80% of malignant thyroid tumors,1 and the prognosis is usually good. PTC can be divided into the following subtypes: infiltrative follicular, tall cell, columnar cell, hobnail, solid, diffuse sclerosing, Warthin-like, and oncocytic subtype. Of these subtypes, tall cell and diffuse sclerosing PTC are among the invasive tumors and are associated with metastasis and poor prognosis.2-5 Lymph node metastases are common in thyroid cancer, accounting for 30–40% of thyroid cancer.6,7 However, distant metastases are rare, accounting for 1–4%.8 A few cases of distant metastasis derived from PTC have been reported, e.g. in the lungs, liver, bone, and brain, etc.9 The recurrence rate of thyroid malignancies and the specific mortality rate are 28% and 9%, respectively.10
A middle-aged woman underwent lobectomy of the thyroid for papillary thyroid carcinoma in another medical institution in 2010, and complete pathological data were not preserved. Eight years after the lobectomy, thyroid cancer recurred, and the patient underwent residual thyroidectomy and neck lymph node dissection in the same hospital. The removed thyroid nodule was approximately 4.5 cm in diameter, and multiple abnormal cervical lymph nodes were found. Postoperative pathological examination reported oncocytic papillary thyroid carcinoma with cervical lymph node invasion. Postoperatively, she refused radioactive iodine (RAI) therapy. One month later, a progressive growth mass 2 cm in diameter was found in the right side of the neck, and the patient underwent mass excision at the local medical facility without pathological examination. In 2021, the patient again presented with a recurrent mass on the right side of the neck (Figure 1) and came to our center for further treatment. Thyroid ultrasonography and contrast-enhanced CT of the neck revealed images of multiple abnormal lymph nodes with a maximum diameter of 6.5 × 6 cm in the right side of the neck (Figure 2A). A lymph node fine-needle aspiration biopsy confirmed lymph node metastasis of thyroid cancer. At the same time, an abnormal nodule measuring 5 × 3.2 cm was found in the upper outer quadrant of the right breast (Figure 2B), and thick-needle aspiration cytology indicated intraductal papilloma (Figure 3A). An immunohistochemical investigation of the breast nodules showed them to be positive for thyroid transcription factor-1 (TTF-1) and thyroglobulin (TG) (Figure 3B and C) but negative for cytokeratin 5/6 (CK5/6) and estrogen receptor (ER). This suggests that the breast nodule metastasis originated from thyroid cancer11 rather than breast cancer.12 In addition, singlephoton emission computerized tomography (SPECT) revealed tumor metastases in the fifth to seventh cervical vertebrae (Figure 2C). The patient refused to continue treatment for personal reasons. She died of cancer cachexia 8 months after leaving the hospital.
The patient reported in this case was initially diagnosed with papillary thyroid carcinoma and underwent thyroid lobectomy at a local hospital, but the patient did not receive oral levothyroxine as endocrine replacement therapy after surgery and was not followed up regularly by the medical facility. The patient rediscovered a mass on her neck 8 years after the initial surgery, and there was still no regular follow-up after the second operation. When the patient went to her doctor with a neck mass 2 years later, metastases of papillary thyroid carcinoma to the breast and spine were found in addition to the recurrent tumor in the neck. During the 11-year course of the disease, patient compliance problems led to extremely poor postoperative management of the tumor, which ultimately resulted in her death.
Papillary thyroid carcinoma is the most common thyroid malignancy and usually has a good prognosis. PTC may develop early neck metastases, while distant metastases are rare. Among organs prone to distant metastases, the lungs are the most common (53.4%), followed by bone (28.1%), liver (8.3%), and brain (4.7%)8,13,14; metastases in other organs, such as breasts, skin, eyes, pancreas, and skeletal muscle, are rare.15-19 Distant metastases significantly increase mortality from PTC, and the median survival time of patients with multiorgan distant metastasis (MODM) is significantly lower than that of patients with single-organ distant metastasis (SODM), i.e., 6 months vs 29 months, respectively. The 5-year survival rate of MODM is also significantly lower than that of SODM, at 15.3% vs 77.6%, respectively.13,20 The patient in this case was found to have distant metastases in the breast and spine when she presented to our center, which may have contributed to her short survival time.
In summary, although papillary thyroid carcinoma generally has a good prognosis, recurrence and distant metastasis or even multi-organ distant metastasis may occur. MODM is significantly associated with poor prognosis in PTC patients. Therefore, the importance of adjuvant therapy (endocrine therapy, biological therapy, radiotherapy, etc.) and regular follow-up after thyroid cancer surgery should be emphasized, and patient compliance should be improved to ameliorate poor disease prognoses.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
This study was supported by the National Natural Science Foundation of China (82070288), the Science & Technology Department of Sichuan Province (2022YFS0627), the Health Commission of Sichuan Province (21PJ100), the Talent Development Project of The Affiliated Hospital of Southwest Medical University (20062).
Data and materials can be obtained from the corresponding authors upon reasonable request.
Ethical approval to report this case was obtained from the ethics committee at the Affiliated Hospital of Southwest Medical University.
Written informed consent was obtained from a legally authorized representative(s) for anonymized patient information to be published in this article.
Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.
Dan Zhang https://orcid.org/0000-0003-3490-6524
Xiao-Ling Zhu https://orcid.org/0000-0002-7562-4470
Jun Jiang https://orcid.org/0000-0003-1292-7236
1 Department of General Surgery (Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, Sichuan Province, China
2 Department of Critical Care Medicine, Deyang People’s Hospital, Sichuan Province, China
# These authors contributed to this work equally.
Corresponding Author:Jun Jiang, Department of General Surgery (Thyroid Surgery), The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang District, Luzhou 646000, Sichuan province, P.R.China.Email: jiangjun@swmu.edu.cn
