Cutaneous metastasis of medullary carcinoma thyroid masquerading as subcutaneous nodules anterior chest and mandibular region

Abstract

Cutaneous metastasis of underlying primary malignancies can present to dermatologist with chief complaints of cutaneous lesions. The underlying malignancy is generally diagnosed much later after a complete assessment of the concerned case. Medullary carcinoma thyroid (MCT) is a relatively uncommon primary neoplasia of the thyroid. Very few cases presenting as cutaneous metastases of MCT have been reported in the literature. Most of the cases which have been reported are of the papillary and the follicular types. We here report a case of a patient who presented in the dermatology clinic with the primary complaint of multiple subcutaneous nodules in anterior chest wall and left side of body of mandible. By systematic application of clinical and diagnostic skills these nodules were diagnosed as cutaneous metastasis of MCT bringing to the forefront a history of previously operated thyroid neoplasm. So clinically, the investigation of a flesh coloured subcutaneous nodule, presenting with a short duration, particularly in scalp, jaw, or anterior chest wall should include possibility of metastastic deposits. A dermatologist should keep a possibility of an internal organ malignancy in patients while investigating a case of flesh coloured subcutaneous nodules, presenting with short duration. A systematic application of clinical and diagnostic skills will eventually lead to such a diagnosis even when not suspected clinically at its primary presentation. A prompt and an emphatic diagnosis and treatment will have its bearing on the eventual outcome in all these patients.

Figure 1

(a) Subcutaneous nodule seen in the anterior chest wall below the right breast. (b) Another subcutaneous nodule seen in the anterior chest wall just near the left breast. (c) Subcutaneous nodule in the mandible.

Figure 2

(a) Singly scattered cellular aspirate with cells of variable sizes and shapes on fine needle aspiration [MGG ×100]. (b) Higher magnification exhibiting predominantly oval and spindloid to plasmacytoid cells on fine needle aspiration [H & E 400x].

Figure 3

(a) Destruction of the right 4th rib along with erosion of the spinous processes of the thoracic vertebra and sclerotic lesions in the body of the vertebrae. (b) Destruction of the floor of middle cranial fossa, posterior ethmoidal air cells and sphenoid sinus. (c) Lesions in the mediastinum. (d) In liver multiple variable sized heterogeneous lesions containing foci of calcification were observed.

Figure 4

(a) Small nests of cohesive malignant cells within areas of hemorrhage [H & E 100x]. (b) Higher magnification detailing the cell morphology of spindle to oval shaped cells [H & E 400x].