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Case Reports
. 2015 Jul 16:16:459-68.
doi: 10.12659/AJCR.894935.

Follicular Variant of Papillary Thyroid Cancer with Bilateral Renal Metastases Discovered Incidentally During Work-Up of Primary Endometrial Cancer: A Rare Occurrence

Sandeep Singh Lubana  1 , Navdeep Singh  1 , Sandeep S Tuli  2 , Tayyaba Bashir  3 , Issac Sachmechi  4 , Margaret M Kemeny  5
Affiliations
Case Reports

Follicular Variant of Papillary Thyroid Cancer with Bilateral Renal Metastases Discovered Incidentally During Work-Up of Primary Endometrial Cancer: A Rare Occurrence

Sandeep Singh Lubana et al. Am J Case Rep. .

Abstract

Background: Follicular variant of papillary thyroid cancer (FV-PTC) is the second most common subtype of papillary thyroid cancer (PTC) after classic PTC. FV-PTC is characterized by nuclear features consistent with classic PTC but has a follicular architecture that lacks classic papillary morphology. Thyroid cancer rarely metastasizes to the kidney. Only 6 cases of FV-PTC metastasizing to the kidney have been reported in the English literature. We are reporting a case of FV-PTC with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer.

Case report: A 70-year-old woman presented with post-menopausal bleeding secondary to endometrial cancer. Staging work-up showed multiple bilateral lung nodules, bilateral soft tissue kidney masses, and multinodular goiter. The pathological and immnohistochemical profile of the lung biopsy was consistent with primary well-differentiated lung adenocarcinoma. Follow-up computerized tomography scan showed stable lung nodules and enlarging renal masses, which was suggestive of bilateral renal cancer. While the histologic features of the renal biopsy were not typical, the immunohistochemical staining of renal biopsy was positive for Paired box 8, thyroid transcription factor-1, thyroglobulin, and cytokeratin 7, suggesting the thyroid as the primary cancer site. The final histopathology on surgical specimen of total thyroidectomy revealed follicular variant of papillary thyroid cancer.

Conclusions: The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites. The clinician should be aware of the possibility of metastasis and look for the primary source, which in the present case was FV-PTC. Immunohistochemistry plays an important role in determining the primary site of origin. In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

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Figures

Figure 1.
Figure 1.
Endometrial biopsy showing endometrial complex glandular hyperplasia with atypia and focal well-differentiated adenocarcinoma.
Figure 2.
Figure 2.
Axial CT images demonstrates (A) multiple bilateral pulmonary nodules and (B) bilateral exophytic, enhancing, renal masses.
Figure 3.
Figure 3.
(A, B) PET/CT demonstrates mild uptake in a partially calcified nodule in the left thyroid.
Figure 4.
Figure 4.
(A, B) Bilateral exophytic renal masses are metabolically active. The left renal mass has a central low density that is not avid on PET and suggests necrosis/cystic degeneration.
Figure 5.
Figure 5.
(A, B) Left perihilar nodule is mildly avid on PET and nearly isointense to mediastinal background.
Figure 6.
Figure 6.
(A, B) Mildly avid lytic lesion on PET in right greater trochanter.
Figure 7.
Figure 7.
(A, B) Lung biopsy showing neoplasm with clear cell features.
Figure 8.
Figure 8.
(A, B) Kidney biopsy showing papillary carcinoma with clear cell features.
Figure 9.
Figure 9.
Immunohistochemical staining of kidney biopsy revealing tumor cells positive for thyroid transcription factor-1.
Figure 10.
Figure 10.
Immunohistochemical staining of kidney biopsy revealing tumor cells positive for thyroglobulin.
Figure 11.
Figure 11.
(A, B) Ultrasonography of thyroid gland showing abnormal texture with focal nodules in both the thyroid lobes. A solid nodule occupies the entire right lobe. Solid nodule with calcified borders noted in the middle part of the left lobe.
Figure 12.
Figure 12.
(A, B) Histology of the thyroidectomy specimen showing papillary carcinoma, follicular variant, with focal clear cell differentiation.
Figure 13.
Figure 13.
A total body iodine-131 scan demonstrates severe, widespread iodine avid metastatic disease seen in the thyroid lungs (red arrow), right (blue arrow) and left (yellow arrow) kidney, lungs (white arrow) and greater trochanter (green arrow).
Figure 14.
Figure 14.
Encapsulated FV-PTC and infiltrative FV-PTC have clinical behavior similar to follicular adenoma and classic PTC, respectively.
See this image and copyright information in PMC

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