Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 
CASE REPORT
Ahead of print publication  

Synchronous columnar cell variant of papillary thyroid carcinoma with invasive breast carcinoma


 Department of Pathology, Government Medical College, Nagpur, Maharashtra, India

Date of Submission27-Aug-2020
Date of Decision05-Oct-2020
Date of Acceptance01-Jan-2021
Date of Web Publication03-Nov-2021

Correspondence Address:
Vedita Bobde,
1/4 Patrakar Colony, Vasant Nagar, Nagpur, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_1255_20

 > Abstract 


Synchronous or metachronous associations of multiple malignancies are seen commonly in syndromic cases. Double malignancies with thyroid carcinomas are common with papillary thyroid carcinoma (PTC) than with other differentiated thyroid cancers. The presence of double malignancy should be ruled out before treatment as it may need different and multiple treatment modalities. We report a case of a columnar cell variant of PTC with invasive breast carcinoma in 56-year-old female patient. The columnar cell variant of PTC is rare and show inconspicous classical nuclear features of conventional PTC.

Keywords: Columnar cell variant of papillary thyroid carcinoma, invasive breast carcinoma, synchronous malignancy



How to cite this URL:
Bobde V, Helwatkar S, Raut W. Synchronous columnar cell variant of papillary thyroid carcinoma with invasive breast carcinoma. J Can Res Ther [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=329850




 > Introduction Top


Multiple primary malignancies are seen in syndromic association in Lynch syndrome and Cowden syndrome however sporadic association of the same is rare. Double malignancy either synchronous or metachronous with differentiated thyroid carcinoma is rarely reported. There are few case reports and case series about various synchronous malignancies with papillary thyroid carcinomas (PTC), especially invasive breast carcinomas in the female.[1] Other malignancies are reported even less such as squamous cell carcinoma, melanoma, or bone tumors with primary thyroid carcinomas. A review of the possible association between thyroid and breast carcinoma was done by Dong et al. and reported that there is a possible relationship between these two cancers as both of them are regulated by the hypothalamus pituitary axis.[1] Patients are diagnosed frequently with these two malignancies than with other organs. An et al. in their case-control study suggested that the risk of developing second primary breast carcinoma or thyroid carcinoma is much higher in patients who previously had thyroid or breast malignancy, respectively. There is a possible relationship between increase iodine uptake and the development of thyroid carcinoma. Dietary iodine deficiency, intracellular iodine deficiency may play a role in the development of carcinogenesis in these two organs.[2]


 > Case Report Top


We report a case of synchronous columnar cell variant of PTC and invasive breast carcinoma (no special type) in a 56-year-old female. We reviewed the available literature about double malignancies involving thyroid and breast malignancies in short. She came with the complaints of anterior neck swelling and difficulty in deglutition for the last 6 months. Neck swelling was gradually increasing while she noticed a small lump in the upper inner quadrant of the right breast 3 months back. The clinical diagnosis was kept as thyroid malignancy with metastasis in the right breast. On examination, swelling was noted on the right side of the anterior neck of size 4 cm × 3 cm × 2 cm, painless on palpation that moves with deglutition. The breast lump was of size 3 cm × 2 cm × 2 cm, hard and painless, not fixed to the underlying chest wall or overlying skin in the upper inner quadrant. Ultrasound-guided fine-needle aspiration cytology was performed from both the lumps. There were no other lesions noted in the rest of the thyroid, both breasts, cervical, or axillary lymph nodes on ultrasonography. Thyroid lump was reported as PTC and breast lump was reported as an epithelial malignancy on cytology. The patient underwent total thyroidectomy with lumpectomy from the right breast lump [Figure 1]. Gross specimen. Total thyroidectomy and breast lumpectomy. Microscopy showed well-circumscribed tumor showing features of columnar cell variant of PTC with central hyalinization and calcification. Long slender papillae arranged in the parallel pseudostratified array were seen. These thin papillae and gland-like structures were lined by pseudostratified epithelium. Nuclear features of PTC were not fully developed in this rare variant. Other lobes of the thyroid and isthmus were free from tumor infiltration. Breast lump showed features of invasive breast carcinoma of no special type (IDC NST) infiltrating into the surrounding fibrofatty tissue. Modified Bloom Richardson grade was II. Surgical margins were free. Immunohistochemistry was done that showed thyroid transcription factor 1 and cytokeratin positivity in the columnar cell variant of PTC. Breast lump was estrogen receptor and progesterone receptor negative and Mamaglobin and GATA positive. HER2 neu showed strong membrane positivity [Figure 2] and [Figure 3]. Microscopy and immunohistochemistry images. To the best of our knowledge, this is the first case report of the synchronous association of columnar cell variant PTC with breast invasive ductal carcinoma (IDC).{Figure 1]
Figure 2: (a and d) Parallel pseudostratified array of cells in columnar cell variant of papillary thyroid carcinoma (H and E stain, ×400). (b) Strong cytoplasmic cytokeratin positivity. (c) Nuclear positivity of thyroid transcription factor 1 stain

Click here to view
Figure 3: (a) Breast invasive ductal carcinoma (no special type) (H and E stain, ×400). (b) Strong membranous HER2 neu positivity. (c) GATA3 nuclear positivity in epithelial cells. (d) Estrogen receptor negative

Click here to view



 > Discussion Top


Thyroid cancer survivors have higher chances of developing other synchronous malignancies, especially breast carcinomas after radiation therapy or due to genetic and hormonal factors.[3] Zhang et al. noted that the most common types of the double primary cancers after breast cancer were thyroid cancer, endometrial cancer, cervical cancer, stomach cancer, and lung cancer.[4] 13.1% of cancer in men and 13.7% of cancers in women are multiple primary cancers and any survivor of cancer has twice the probability of developing a new second primary cancer than a cancer-free individual.[5] The Surveillance, Epidemiology and End Results program of the US National Cancer Institute examined cancer patients who were diagnosed between 1973 and 2000, indicated significantly increased risk for secondary thyroid cancer compared with the general population. Thyroid cancer survivors exhibited an increased occurrence of second cancer.[5] They postulated that radiation therapy to most of those bearing head and neck cancer probably plays a role in this association. Our patient had not received any chemotherapy or radiation therapy previously. Stages of both the cancers were low as no metastasis was seen in cervical or axillary lymphnodes on radiology. Which tumor developed first could not be ascertained being organ-confined disease. Similar finding was noted by Zhong et al.[6] However, they postulated thyroid carcinoma as first to develop depending on poorer TNM stage of their patient.

All three breast cancers were HER2 positive in their case series of three cases done by Gao et al. along with PTCs suggesting that HER2-positive breast cancer may be at a higher risk for thyroid cancer than other cancers. They found 2 distinct types of cancer metastasized to 1 lymph node in a patient suggesting a high index of suspicion is needed and the use of immunohistochemical stain to confirm multiple primary tumors metastasis to single lymph node.[7] Bardhan et al. reported two male patients with HER2-positive breast cancer who also developed thyroid cancer, and suggested that women with HER2-positive breast cancer may have a higher risk for thyroid cancer.[8] In contrast with the present case in Yu et al. study all invasive breast cancers were ER-positive and HER2 negative on immunohistochemistry occurring in synchronous or metachronous association with PTC.[3] Zeng et al. also reported a metachronous HER2-positive breast cancer with thyroid cancer with a collision metastasis in a single cervical lymphnode.[9] These findings suggest that further molecular studies are warranted to study the association of HER2 positive breast cancer with thyroid cancer. A rare incidental case of vascular micrometastasis of HER2 positive occult breast carcinoma in PTC was noted by Kaur et al.[10] Various factors are required to differentiate between the types of synchronous primary tumor, including the common risk factors, and also diagnostic and treatment strategies. After nine months of surgery, our patient was alive and well. Unfortunately, she lost to follow-up after that ignoring advice of modified radical mastectomy by the treating surgeon.


 > Conclusion Top


Synchronous association of thyroid carcinoma is common with breast carcinomas than with other organ's malignancies. HER2-positive tumors should be further followed for the development of other primary carcinomas. That can add to the bad prognosis of these patients. Among all differentiated thyroid carcinomas, PTC is most common which could be the reason of more number of cases involved in double malignancies with PTC. A thorough clinical and radiological examination can detect the other primary malignancy in early stage and can contribute to better survival of these patients.

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 initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We are thankful to the department of pathology, Armed Forces Medical College, Pune for providing immunohistochemistry slides for this case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Dong L, Lu J, Zhao B, Wang W, Zhao Y. Review of the possible association between thyroid and breast carcinoma. World J Surg Oncol 2018;16:130.  Back to cited text no. 1
    
2.
An JH, Hwangbo Y, Ahn HY, Keam B, Lee KE, Han W, et al. A possible association between thyroid cancer and breast cancer. Thyroid 2015;25:1330-8.  Back to cited text no. 2
    
3.
Yu F, Ma J, Huo K, Li P. Association between breast cancer and thyroid cancer: A descriptive study. Transl Cancer Res 2017;6:393-401.  Back to cited text no. 3
    
4.
Zhang L, Wu Y, Liu F, Fu L, Tong Z. Characteristics and survival of patients with metachronous or synchronous double primary malignancies: Breast and thyroid cancer. Oncotarget 2016;7:52450-9.  Back to cited text no. 4
    
5.
Hsu CH, Huang CL, Hsu YH, Iqbal U, Nguyen PA, Jian WS. Co-occurrence of second primary malignancy in patients with thyroid cancer, QJM: Int J Med 2014;107:643-8.  Back to cited text no. 5
    
6.
Zhong J, Lei J, Jiang K, Li Z, Gong R, Zhu J. Synchronous papillary thyroid carcinoma and breast ductal carcinoma: A rare case report and literature review. Medicine (Baltimore) 2017;96:e6114.  Back to cited text no. 6
    
7.
Gao Q, Zheng Y, Wang B, Wu Z, Ren G. Three metachronous cases of HER2-positive breast cancer accompanied with thyroid cancer. Breast Care (Basel) 2014;9:360-3.  Back to cited text no. 7
    
8.
Bardhan P, Bui MM, Minton S, Loftus L, Carter WB, Laronga C, et al. HER2-positive male breast cancer with thyroid cancer: An institutional report and review of literature. Ann Clin Lab Sci 2012;42:135-9.  Back to cited text no. 8
    
9.
Zeng H, Liu C, Zeng YJ, Wang L, Chen GB, Shen XM. Collision metastasis of breast and thyroid carcinoma to a single cervical lymph node: Report of a case. Surg Today 2012;42:891-4.  Back to cited text no. 9
    
10.
Kaur J, Sharma S, Bhasin TS, Agarwal R, Mannan R. A rare incidental case of an occult breast carcinoma micrometastasis in papillary thyroid carcinoma: A view within a view. Thyroid Res Pract 2018;15:142-6.  Back to cited text no. 10
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

 
Top
 
 
  Search
 
     Search Pubmed for
 
    -  Bobde V
    -  Helwatkar S
    -  Raut W
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  >Abstract>Introduction>Case Report>Discussion>Conclusion>Article Figures
  In this article
>References

 Article Access Statistics
    Viewed107    
    PDF Downloaded2    

Recommend this journal