Skin Metastasis Occurring 30 Years After Thyroidectomy for Papillary Thyroid Carcinoma

Abstract

The skin is an extremely rare site of metastasis from papillary thyroid carcinoma (PTC) and is linked to underlying disseminated malignancy, which reflects a dismal prognosis. We present the case of a 70-years-old Saudi female who presented at our clinic with an eight-month history of two painful and itchy skin nodules over the scalp and the medial aspect of the right arm. She had a history of total thyroidectomy for PTC 30 years prior. Computed tomography-positron emission tomography showed multiple fluorodeoxyglucose avid lung and skeletal metastases. This case highlights the fact that skin nodules in a patient with a history of PTC should be assessed carefully with a high suspicion of skin metastasis to avoid any delay in treatment.

Keywords: diagnosis; metastasis; papillary thyroid carcinoma; skin; treatment.

Figure 1. Erythematous nodule on the scalp (A) and the medial aspect of the right arm (B).

Figure 2. (A) Low-power view hematoxylin and eosin staining showing a papillary structure in the dermis. High-power view revealing (B) a fibrovascular core with papillary tumor cells containing large nuclei, nuclear grooves, and cytoplasmic pseudo-inclusions. Immunohistochemical staining positive for (C) thyroid transcription factor-1 and (D) thyroglobulin.