Unusual cutaneous metastatic follicular thyroid carcinoma

Abstract

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer (TCs) after papillary carcinoma, but it is ranked first in producing distant metastases among TCs. It accounts for 10 - 20% of all thyroid malignancies and is most often seen in patients over 40 years of age. Distant metastases at the time of diagnosis are reported in 11 - 20% of the patients and may be the reason for presentation. There have been less than 30 reported cases of cutaneous metastases from FTC in the English Literature, a majority affecting the scalp. We present an unusual aggressive, hypervascular FTC in a 58-year-old man with a previous diagnosis of multinodular goiter. The difficulty in gaining his acceptability of orthodox management resulted in the development of multiple giant scalp and right facial metastatic masses associated with lytic calvarial destruction and the involvement of frontal and right maxillary sinuses. These imposed serious challenges in managing him in a resource-poor community.

Keywords: Multinodular goiter; skull metastasis; thyroid follicular carcinoma.

Figure 1

(a,b) Photographs of the 58-year-old man with metastatic follicular thyroid carcinoma showing multiple scalp and facial masses. Note in a and b the tortuous and engorged superficial vessels on the left upper aspect of the face and in (b) the right sided thyroid swelling

Figure 2

(a,b) Skull radiographs of the same patient. (a) Occipitofrontal view showing overlapping shadows of the skull masses and masses within the nasal cavity causing ill-definition of the nasal septum. (b) Multiple lytic skull vault lesions with ragged edges and radiating bony stands from the vault into the skull masses. Note the branching lucencies to the direction of the lytic lesion and the overlying masses, suggesting hypervascularity

Figure 3

Patient chest radiograph showing thyroid mass essentially to the right of midline in the lower aspect of the neck, tracheal deviation to the left, coronal tracheal narrowing and retrosternal extension. Note the hilar soft tissue masses with lobulated margin presumed to be lymphadenopathy