Recurrent Hurthle cell thyroid carcinoma does not preclude long-term survival: a case report and review of the literature

Abstract

Background: Follicular thyroid carcinoma is the second most common malignancy of the thyroid gland. In 2016, the so-called Hurthle cell thyroid carcinoma, formerly known as the oxyphilic variant of the follicular thyroid carcinoma, was reclassified by the World Health Organization as a separate pathological entity, which accounts for approximately 3% of all thyroid cancers. Although Hurthle cell thyroid carcinomas are known for their more aggressive tumor biology, metastases are observed in a minority of cases, and long-term survival can be expected. However, disseminated disease is often associated with poor outcome.

Case presentation: In the presented case, a 63-year-old Caucasian female was incidentally diagnosed with Hurthle cell thyroid carcinoma after undergoing hemithyroidectomy for a nodular goiter. Following completion thyroidectomy, two courses of radioactive iodine therapy were administered. After 4 years of uneventful follow-up, the patient gradually developed metastases in five different organs, with the majority representing unusual sites, such as heart, kidney, and pancreas over a course of 14 years. The lesions were either treated with radioactive iodine therapy or removed surgically, depending on iodine avidity.

Conclusion: Follicular and Hurthle cell thyroid carcinoma are known to potentially spread hematogenously to typical sites, such as lung or bones, however; unusual metastatic sites as presented in our case can also be observed. A search of the literature revealed only scattered reports on patients with multiple metastases in unusual locations. Furthermore, the observed long-term survival of our patient is contradictory to the existing data. As demonstrated, recurrent disease may appear years after the initial diagnosis, emphasizing the importance of consistent aftercare. Radioactive iodine therapy, extracorporeal radiation therapy, and surgical metastasectomy are central therapeutic components. In summary, our case exemplifies that thorough aftercare and aggressive treatment enables long-term survival even in recurrent Hurthle cell thyroid carcinoma displaying unusual multisite metastases.

Keywords: Cardiac metastasis; Case report; Follicular thyroid carcinoma; Hurthle cell carcinoma; Multisite metastases; Pancreatic metastasis; Unusual metastases.

Fig. 1

Ratio of thyroglobulin (TG) to thyrotropin (TSH) [µg/mU] at selected points in time during follow-up. Black arrows mark the surgical interventions. White arrows mark the radioactive iodine (RAI) therapies

Fig. 2

Schematic presentation of the metastatic site. A Axial computed tomography (CT) image of the thorax with the lung metastasis in the left lower lobe (white circle). B Axial magnetic resonance imaging (MRI) image of the thorax. The arrow marks the heart metastasis in the right atrium. C Axial MRI image of the upper abdomen depicting the pancreatic tail metastasis (arrow). D Axial CT image of the abdomen with metastasis in the right superior renal pole (arrow). E Axial CT image of the chest. The white circle marks one of the metastases in the right upper lobe. F Axial MRI image of the right shoulder, depicting a contrast enhancing the metastasis in the deltoid muscle (arrow)