ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
Case Report

Case Report: Rare case of Cutaneous Metastasis of Follicular Thyroid Carcinoma.

[version 1; peer review: awaiting peer review]
PUBLISHED 02 Aug 2024
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS AWAITING PEER REVIEW

Abstract

Follicular thyroid cancer (FTC) is the second most common differentiated thyroid cancer, accounting for approximately 10–15% of all thyroid cancers. Skin metastasis is rare, and only 30 cases have been documented as of 1997. Here, we present a rare case of cutaneous metastasis of follicular thyroid carcinoma with clinical, dermoscopic, and histopathological findings as well as an ongoing management plan. The rarity of this disease often presents diagnostic difficulties, and in this case report, we highlight the challenges and methods to address them.

Keywords

Metastasis, Follicular Carcinoma, Thyroid, Cutaneous, Dermoscopy

Introduction

Follicular thyroid cancer (FTC) is the second most common differentiated thyroid cancer, accounting for approximately 10–15% of all thyroid cancers.1 In 1997, a review of the English literature was conducted, and only 30 cases of Metastasis of Follicular Carcinoma of the Thyroid to the skin were documented.2 The most common location in the head and neck area.3

Poor prognosis and mortality rates are common for distant metastasis, such as to the lungs and bone, and disease-specific mortality is around 40% at a median follow-up of 5 years;1 however, no data are available for prognosis and mortality of metastasis to the skin. Here, we present a rare case of Metastatic Follicular Carcinoma of the Thyroid using dermoscopic, radiographic, and histopathological images.

Case report

A 49-year-old Southeast Asian woman with a past medical history of diabetes, hypertension, hyperlipidemia, and follicular thyroid cancer, which was fully removed surgically in 2019 in a complete thyroidectomy, shortly followed by one session of radioactive iodine 131, demonstrated no evidence of local or distant metastatic lesions, and presented with a suspicious solitary lesion that was noted on the anterior side of the neck. The lesion was originally a small macule that was black to brown in color and grew to become a red papule over the previous 4 months, coinciding with almost 18 months after her radioactive iodine session.

She is not currently on any immunosuppressants.

Family history was notable for a skin lesion on the father’s back, and surgery was performed. The patient was unaware of the histopathology results, but was told that it was benign in nature.

On further examination the lesion was an erythematous papule, 0.9 × 0.8 cm and blanchable in the center, it was non-tender to touch, and the lymph nodes were non-palpable during the examination (Figure 1).

d6058f71-5d03-46e6-b00c-2de75be04ef0_figure1.gif

Figure 1. Clinical presentation of an erythematous papule, 0.9 × 0.8 cm and blanchable in the center.

Examination using a dermatoscope revealed arborizing vessels on the periphery, with a pink structureless area in the center (Figure 2).

d6058f71-5d03-46e6-b00c-2de75be04ef0_figure2.gif

Figure 2. Dermoscopic presentation with arborizing vessels noted on the periphery.

Absence of features in the center.

A 4 mm punch biopsy from the center of the lesion was performed with a clinical differential diagnosis of a basal cell Carcinoma and a Hidradenoma.

Laboratory tests revealed a steady rise in thyroglobulin levels from 1.5 ng/ml to 15 ng/ml, 6 months and 1 month prior to the visit, respectively, with a low TSH level at 0.01 mlU/L on the same visits.

The biopsy results revealed a normal epidermis with an underlying dermal tumor that was rich in follicles with colloids (a T3, T4 precursor) and was strongly positive for Thyroglobulin and Thyroid transcription factor-1 (TTF-1) on immunohistochemistry. Highly suggestive of follicular carcinoma of the thyroid metastasis (Figure 3).

d6058f71-5d03-46e6-b00c-2de75be04ef0_figure3.gif

Figure 3. Histopathology images.

A, B, hematoxylin-eosin stain; magnification; C, Thyroglobulin and Thyroid transcription factor-1 immunohistochemistry.

After informing the patient of the diagnosis, she was referred to the thyroid multidisciplinary team (MDT).

The MDT decided to initiate therapeutic and diagnostic radioactive Iodine-131 therapy for thyroid cancer.

48 hours after administration of Iodine-131, 1093 megabecquerels (MBq), the scan demonstrated a small remnant of thyroid tissue in the thyroid bed. Single-photon emission computed tomography (SPECT/CT) imaging revealed focal uptake corresponding to a 5 mm diameter subcutaneous nodule in the midline of the neck, 1 cm below the lower margin level of the thyroid cartilage (Figure 4). The patient will continue to receive radioactive Iodine-131 therapy as decided by the thyroid multidisciplinary team.

d6058f71-5d03-46e6-b00c-2de75be04ef0_figure4.gif

Figure 4. Single-photon emission computed tomography (SPECT/CT) imaging, and a 5 mm anterior neck midline focal uptake.

Discussion

Follicular thyroid cancer (FTC) is the second most common differentiated thyroid cancer, accounting for approximately 10–15% of all thyroid cancers.1 In 1997, a review of the English literature was conducted, and only 30 cases of metastasis of follicular carcinoma of the thyroid to the skin were documented.2

The rarity of this disease and its cutaneous presentation may present as a difficulty when encountered in the clinical setting, history, and clinical examination may not be sufficient to confidently verify the diagnosis and hence a low threshold of secondary diagnostics may be needed, metastatic lesions are even more difficult to diagnose as they can have a variable presentation; however, when the clinical and even dermoscopic appearance do not fit with diseases typically seen in the dermatology realm, then this should evoke further investigations. Some dermoscopic structures are shown (Figure 2) may have been suggestive of a BCC However, the features seen in arborizing vessels are nonspecific and arise in many other tumors,4 and with the increasing use of dermoscopy in various practices, more patterns will eventually be recognized, both for rare and common disorders. However, we could not identify any articles describing the dermoscopic findings of metastasis of follicular carcinoma of the thyroid to the skin. We hope that the images we shared and the findings described could facilitate the identification of such tumors in the future.

Consent

Patient consent statement: The authors obtained written consent from patients for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but were retained by the authors.

Author contributions

Conceptualization: MNA-A, BA-M; Writing – Original Draft and Preparation: MNA-A, SMK, SAA, BA-M, AA-M; Writing – review and editing: MNA-A, BA-M, AA-M.

Subject: Metastatic Follicular Carcinoma of the Thyroid, rare cutaneous presentation.

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 02 Aug 2024
Comment
Author details Author details
Competing interests
Grant information
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
- -
Citations
CITE
how to cite this article
Al-Abdulla MN, Koshy SM, Alhyassat SA et al. Case Report: Rare case of Cutaneous Metastasis of Follicular Thyroid Carcinoma. [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:875 (https://doi.org/10.12688/f1000research.148998.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status:
AWAITING PEER REVIEW
AWAITING PEER REVIEW
?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 02 Aug 2024
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
Sign In
If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

The email address should be the one you originally registered with F1000.

Email address not valid, please try again

You registered with F1000 via Google, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Google account password, please click here.

You registered with F1000 via Facebook, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Facebook account password, please click here.

Code not correct, please try again
Email us for further assistance.
Server error, please try again.