Unusual presentation of follicular carcinoma thyroid with special emphasis on their management

Abstract

Introduction: Follicular carcinoma of thyroid usually behaves in an indolent manner with low metastatic potential. Distant metastases as initial presentation is rare in follicular carcinoma; especially in young patients.

Presentation of case: We report the clinical, pathological features and the management of three different cases of follicular carcinoma of the thyroid with unusual presentations at the time of diagnosis. First case presented as thyroid abscess, second case with a large skull swelling in a pre-exiting goiter and the third case with a swelling in the sternum.

Discussion: Follicular carcinoma of thyroid is the second category of well-differentiated thyroid cancer that constitutes about 10% of all thyroid malignancies. Blood borne metastasis is common with spread to lung, bone and other solid organs. In less than 10% cases of follicular carcinoma, there is evidence of lymphatic involvement. The patients' presentations above are highly unusual.

Conclusion: Recognizing these cases has a significant impact on clinical decision-making and prognosis of the patients. Treatment in these patients should be individualized and an alternative therapeutic approach should be considered.

Fig. 1

First case, a 25 yr female of follicular carcinoma of thyroid presenting as thyroid abscess.

Fig. 2

(A) Second case, a 40 yr old lady with metastasis over skull bone (B)–(D) CT head showing large fronto-parietal mass eroding through the skull, and extending into the scalp and intracranially. (E) Histopathology showing follicular carcinoma with lymphovascular invasion.

Fig. 3

Third case, a 45 year old lady with follicular carcinoma thyroid with sternal metastasis.