Metastatic colorectal cancer to a primary thyroid cancer

Abstract

Background: Metastatic malignancy to the thyroid gland is generally uncommon due to an unfavourable local thyroid micro-environment which impairs the ability of metastatic cells to settle and thrive. Metastases to the thyroid gland have however been reported to occur occasionally particularly if there has been disruption to normal thyroid tissue architecture.

Case presentation: We report a patient with a history of surgically resected rectal adenocarcinoma who presents with a rising serum CEA level and an 18F-FDG PET scan positive thyroid nodule which was subsequently confirmed at surgery to be a focus of metastatic rectal adenocarcinoma within a primary poorly differentiated papillary thyroid carcinoma.Subsequent treatment involved right hemi-thyroidectomy, pulmonary wedge resection of oligometastatic metastatic colorectal cancer and chemotherapy.

Conclusion: Metastatic rectal carcinoma to the thyroid gland and in particular to a primary thyroid malignancy is rare and unusual. Prognosis is likely to be more dependent on underlying metastatic disease rather than the primary thyroid malignancy hence primary treatments should be tailored towards treating and controlling metastatic disease and less emphasis placed on the primary thyroid malignancy.

Figure 1

CT scan demonstrating 4.3 × 2.5 cm partially calcified complex dominant nodule in the inferior pole of the right lobe of thyroid.

Figure 2

¹⁸F-FDG PET/CT scan demonstrating focal intense ¹⁸F-FDG uptake in the nodule in the inferior pole of the right lobe of thyroid.

Figure 3

Histological examination of the thyroid nodule revealed (A) poorly differentiated primary papillary thyroid carcinoma intermixed with (B) foci of metastatic rectal adenocarcinoma i H&E Low power ×10 ii H&E High Power ×20.

Figure 4

Histological examination of the resected pulmonary nodule revealed (B) metastatic rectal adenocarcinoma in a background of (C) normal lung parenchyma. H&E High Power ×20.