Clinicopathological and Molecular Features of Secondary Cancer (Metastasis) to the Thyroid and Advances in Management

Abstract

Secondary tumours to the thyroid gland are uncommon and often incidentally discovered on imaging. Symptomatic patients often present with a neck mass. Collision tumours of secondary tumours and primary thyroid neoplasms do occur. Ultrasound-guided fine-needle aspiration, core-needle biopsy, and surgical resection with histological and immunohistochemical analysis are employed to confirm diagnosis as well as for applying molecular studies to identify candidates for targeted therapy. Biopsy at the metastatic site can identify mutations (such as EGFR, K-Ras, VHL) and translocations (such as EML4-ALK fusion) important in planning target therapies. Patients with advanced-stage primary cancers, widespread dissemination, or unknown primary origin often have a poor prognosis. Those with isolated metastasis to the thyroid have better survival outcomes and are more likely to undergo thyroid resection. Systemic therapies, such as chemotherapy and hormonal therapy, are often used as adjuvant treatment post-operatively or in patients with disseminated disease. New targeted therapies, such as tyrosine kinase inhibitors and immune checkpoint inhibitors, have shown success in reported cases. A tailored treatment plan based on primary tumour features, overall cancer burden, and co-morbidities is imperative. To conclude, secondary cancer to the thyroid is uncommon, and awareness of the updates on diagnosis and management is needed.

Keywords: metastases; pathology; prognosis; secondary; thyroid; treatment.

Figure 1

(A) Histology of a collision tumour in thyroid with primary follicular carcinoma (FCA) and metastatic renal cell carcinoma (RCC); (B) TTF-1 immunohistochemical stain is positive in the follicular cell carcinoma component; (C) CD10 immunohistochemical stain is positive in the renal cell carcinoma component.

Figure 2

An overview of the assessment and management of potential metastasis to the thyroid. US, ultrasound; FNA, fine-needle aspiration; CNB, core-needle biopsy; CT, computed tomography; PET, fluorodeoxyglucose-positron-emission tomography.