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CASE REPORT
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Breast metastasis in follicular thyroid cancer patient


1 Department of Nuclear Medicine, School of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
2 Department of Endocrinology, School of Medicine, Sivas Cumhuriyet University, Sivas, Turkey

Date of Submission11-Jul-2020
Date of Decision29-Aug-2020
Date of Acceptance27-Oct-2020
Date of Web Publication23-Sep-2021

Correspondence Address:
Seyit Ahmet Ertürk,
Department of Nuclear Medicine, School of Medicine, Sivas Cumhuriyet University, P.K. 848, 58140, Campus-Sivas
Turkey
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_957_20

 > Abstract 


In this case report, we aimed to present the findings of a follicular thyroid carcinoma patient with breast metastasis, which is rarely reported in the literature. A 33-year-old female who had been operated for thyroid cancer 17 years ago, but whose pathology report could not be reached was suspected of recurrence in the left lobe region of the thyroid gland. Fine-needle aspiration biopsy was done in this region, and the biopsy result was reported as thyroid follicular carcinoma. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was performed for re-staging before surgery. In the PET/CT, it was found that there was residual thyroid tissue in the right and left lobe region and superior to these lesions in the left side, there were lesions which destruct to the hyoid bone, and there were multiple nodular lesions in both lungs which measured with maximum 15 mm × 12 mm, and all these lesions have increased 18F-FDG uptake. In addition to these lesions, a nodular lesion with the size of ~11 mm ×10 mm in the upper-middle quadrant of the right breast, and it was showing increased 18F-FDG uptake (maximum standardized uptake value: 3). Pathology results of the left neck region operation materials were reported as papillary and follicular carcinoma of the thyroid gland. Right lumpectomy was performed for the lesion in the right breast during the same session with thyroid operation. The pathology result of this lesion was also reported as metastasis of thyroid follicular cancer. Posttreatment iodine-131 whole-body scan after surgery was reported as there was abnormal accumulation in residual thyroid tissues on the right side of the neck and lung metastases. In patients with thyroid cancer, the possibility of metastasis of the breasts should be considered when there is a lesion in the breast tissue.

Keywords: Breast metastasis, iodine-131, thyroid cancer



How to cite this URL:
Ertürk SA, Hasbek Z, Duman G, Sariakçali B. Breast metastasis in follicular thyroid cancer patient. J Can Res Ther [Epub ahead of print] [cited 2021 Dec 5]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=326584




 > Introduction Top


Thyroid cancers are the most common endocrine tumors that develop from thyroid follicular epithelial cells. It consists of four groups, the most commonly differentiated papillary and follicular thyroid cancers, and poorly differentiated and anaplastic carcinoma. Papillary thyroid carcinoma (PTC) is considered one of the most favorable tumors, indolent, with rare distant metastasis. Lungs and bones are the most common metastatic sites. In the literature, the brain, liver, skin, kidney, pancreas, and adrenal gland metastases of PTC are rarely reported.[1] Follicular thyroid cancers most commonly metastasize to the lungs and bone by the hematogenous route. It is a known issue that it rarely metastasizes to the skin, brain, adrenal gland, kidney, and pancreas.[2],[3] Breast, liver, stomach, esophagus, penis, eye, choroid, and submandibular gland metastases have also been reported.[3],[4],[5] In this case report, we aimed to present the findings of a follicular thyroid carcinoma patient with breast metastasis, which is rarely reported in the literature.


 > Case Report Top


A 33-year-old female who had been operated for thyroid cancer 17 years ago, but whose pathology report could not be reached was suspected of recurrence in the left lobe region of the thyroid gland. Fine-needle aspiration biopsy was done in this region, and the biopsy result was reported as thyroid follicular carcinoma. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was performed for re-staging before surgery. In the 18F-FDG PET/CT, it was found that there was residual thyroid tissue in the right and left lobe region and superior to this lesions in the left side, there were lesions which destruct to the hyoid bone and there were multiple nodular lesions in both lungs which measured with maximum 15 mm × 12 mm, and all these lesions have increased 18F-FDG uptake. In addition to these lesions, a nodular lesion with the size of ~11 mm × 10 mm in the upper-middle quadrant of the right breast, and it was showing increased 18F-FDG uptake (maximum standardized uptake value: 3) [Figure 1]. Pathology results of the left neck region operation materials were reported as thyroid follicular carcinoma; tumor diameter is 35 mm, tumor capsule invasion is positive and papillary carcinoma of the thyroid gland with 8 mm tumor diameter. Right lumpectomy was performed for the lesion in the right breast during the same session with thyroid operation. The pathology result of this lesion was also reported as metastasis of thyroid follicular cancer. 200 mCi posttreatment iodine-131 (I-131) whole-body scan after surgery was reported as there was abnormal accumulation in residual thyroid tissues on the right side of the neck and lung metastases in localization compatible with the areas defined in 18F-FDG PET/CT. In laboratory tests during radioiodine treatment, TSH: 15.6 μIU/ml, thyroglobulin: 309.7 ng/mL, antithyroglobulin antibody <10 IU/mL, and these laboratory values were consistent with distant metastatic thyroid cancer. In the laboratory tests performed during the follow-up of at 3 months after radioiodine treatment, TSH: 0.025 μIU/ml, thyroglobulin: 0.266 ng/mL, and the antithyroglobulin antibody was 12.6 IU/mL. Furthermore, TSH was measured as 0.0263 μIU/ml, thyroglobulin 0.067 ng/mL, and antithyroglobulin antibody was <10 IU/mL in blood tests performed ~13 months after treatment, and these laboratory values were consistent with the response to treatment.
Figure 1: Positron emission tomography/computed tomography was showing increased 18F-fluorodeoxyglucose uptake in the upper-middle quadrant of the right breast

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 > Discussion Top


Although primary breast cancer is the most common malignancy in women and breast metastasis most often develops secondary to the malignancy of the opposite breast, breast metastasis from extramammary primary cancers is extremely rare. The incidence of metastatic cancer to the breast is approximately 1%–2%, according to literature.[6] It has been reported that lymphoma-leukemia, melanoma, ovarian carcinoma, and sarcomas can metastasize to the breast in the literature.[7] In the study conducted by Zhou et al.[8], twenty-eight cases with breast metastasis, lung adenocarcinoma in 28.6%, high-grade ovarian serous carcinoma in 17.8%, melanoma in 14.3%, mesenchymal malignant tumors (three rhabdomyosarcomas and one in 14.3%), epithelioid malignant peripheral nerve sheath tumor), gastric adenocarcinoma in 10.7%, rectal adenocarcinoma in 7.1%, pancreatic neuroendocrine carcinoma in 3.6%, and even prostatic carcinoma in 1 case. In the same study, it was found that the pathological features of metastasis in the breast were similar to the primary tumor.

Follicular thyroid cancers account for about 15% of all thyroid cancers and generally spread hematogenous. It is known that differentiated thyroid cancers can rarely metastasize to other organs other than lymph node, lung, and bone metastases. The detection of metastases is very important in terms of treatment management. Because detection of removable metastatic lesions is important for the prognosis of patients, Farina et al stated that rare metastases of thyroid cancers may not be a negative prognostic factor especially if it can be resected.

One of the limitations in our patient was that we did not scan with I-131 for the differential diagnosis of the lesion in the breast, which we noticed on PET/CT, primary lesion of the breast/metastatic lesion of the thyroid. The most important reason for this was that I-131 given low doses for screening might cause a stunning effect, and therefore, it could prevent the success of RAI treatment. Therefore, scanning with radioactive iodine-131 was not performed.


 > Conclusion Top


In patients with thyroid cancer, both at the time of diagnosis and during follow-up, the lesions detected outside the classical metastasis sites should be examined carefully and the possibility of metastasis of the breasts should be considered when there is a lesion in the breast tissue.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Blažeković I, Jukić T, Granić R, Punda M, Franceschi M. An unusual case of papillary thyroid carcinoma iodine-131 avid metastasis to the adrenal gland. Acta Clin Croat 2018;57:372-6.  Back to cited text no. 1
    
2.
Lira ML, Almeida MA, Reis-Feroldi MM, Rocha JA. Follicular thyroid carcinoma metastatic to skin: A small papule and a big diagnostic change. An Bras Dermatol 2019;94:76-8.  Back to cited text no. 2
    
3.
Farina E, Monari F, Tallini G, Repaci A, Mazzarotto R, Giunchi F, et al. Unusual thyroid carcinoma metastases: A case series and literature review. Endocr Pathol 2016;27:55-64.  Back to cited text no. 3
    
4.
Masood S, Davis C, Kubik MJ. Changing the term “breast tumor resembling the tall cell variant of papillary thyroid carcinoma” to “tall cell variant of papillary breast carcinoma”. Adv Anat Pathol 2012;19:108-10.  Back to cited text no. 4
    
5.
Angeles-Angeles A, Chable-Montero F, Martinez-Benitez B, Albores-Saavedra J. Unusual metastases of papillary thyroid carcinoma: Report of 2 cases. Ann Diagn Pathol 2009;13:189-96.  Back to cited text no. 5
    
6.
Parasuraman L, Kane SV, Pai PS, Shanghvi K. Isolated metastasis in male breast from differentiated thyroid carcinoma-oncological curiosity. A case report and review of literature. Indian J Surg Oncol 2016;7:91-4.  Back to cited text no. 6
    
7.
Dursun P, Yanik FB, Kuscu E, Gultekin M, Ayhan A. Bilateral breast metastasis of ovarian carcinoma. Eur J Gynaecol Oncol 2009;30:9-12.  Back to cited text no. 7
    
8.
Zhou S, Yu B, Cheng Y, Xu X, Shui R, Bi R, et al. Metastases to the breast from non-mammary malignancies: A clinicopathologic study of 28 cases. Zhonghua Bing Li Xue Za Zhi 2014;43:231-5.  Back to cited text no. 8
    


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