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Case Reports
. 2024 Jun 4:16:575-583.
doi: 10.2147/CMAR.S470045. eCollection 2024.

Sign of Neck Mass as the Chief Complaint: A Case Report and Literature Review About Thyroid Metastasis of Colorectal Cancer

Zhaorui Wang  1 , Jingjing Wang  1 , Jing Pei  2 , Yubo Pan  2 , Rui Ding  1
Affiliations
Case Reports

Sign of Neck Mass as the Chief Complaint: A Case Report and Literature Review About Thyroid Metastasis of Colorectal Cancer

Zhaorui Wang et al. Cancer Manag Res. .

Abstract

Background: Commonly, the thyroid gland is regarded as an organ with fewer metastatic diseases, and colorectal metastasis to the thyroid (CMT) is rarely reported, especially, with that the clinical sign of thyroid metastasis nidus is the chief complaint. The CMT occurs in advanced colorectal cancer and is associated with poor prognosis and short survival.

Case report: In this case, we reported a patient with the sign of neck mass as the first manifestation of CMT. The patient underwent a partial thyroidectomy in June 2019, immunohistochemical findings of thyroid carcinoma suggested the possibility of adenocarcinoma of gastrointestinal tract. The patient underwent a colonoscopy in July 2019 and a colonic mass was found. Pathological examination diagnosed rectal adenocarcinoma. The patient underwent neoadjuvant chemotherapy, surgical treatment, postoperative adjuvant chemotherapy and targeted therapy. The patient died in June 2022.

Conclusion: The metastasis disease would not be ignored at all, when a patient complains at signs of neck mass. Further, the possibility of metastasis cancer should be considered once thyroid nodules occur in patients with colorectal cancer. Even though the biological characteristics and stage of the primary tumor have an important impact on the prognosis, positive standardized treatments can also be helpful.

Keywords: case report; colorectum cancer metastases; neck mass; prognosis; secondary thyroid cancer; therapy.

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Conflict of interest statement

Dr Yubo Pan is now affiliated with Department of Gastrointestinal Surgery, Yixing People’s Hospital, Yixing, Jiangsu, China. The authors declare that they have no conflicts of interest in this work.

Figures

Figure 1
Figure 1
There were more adulterants in the thyroid gland, with disordered arrangement, some glands fused, and obvious cell atypia. The arrow indicates the heterocyst.
Figure 2
Figure 2
Immunohistochemistry revealed adenoid arrangement of heteromorphic cells with interstitial fibrosis. Immunohistochemistry revealed positive expression of CDX-2 (an intestinal specific transcription factor) and Villin, while negative expression of TG (thyroglobulin), suggesting a high possibility of intestinal metastatic adenocarcinoma. (A) The tumor cells (blue arrows) are adenoid and distributed in the thyroid tissue. And the thyroid follicles can be seen (red arrows); (B) The tumor cells were positive for CDX-2; (C) The tumor cells Villin were positive; (D) TG in thyroid follicles was positive and TG in tumor cells was negative.
Figure 3
Figure 3
Heterotypic glands fused, partially ethmoidal, with marked interstitial fibrosis. The arrow indicates Cribriform heteromorphic cell fusion.
Figure 4
Figure 4
The 18F-FDG PET/CT scan images showing increased focal FDG uptake in the rectal mass and pelvic lymph nodes.
Figure 5
Figure 5
The FDG metabolism of multiple omentum nodules and pelvic peritoneal nodules which have unclear boundary with the anterior wall of rectum was increased.
See this image and copyright information in PMC

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