Journal Information
Vol. 89. Issue 4.
(July - August 2023)
Share
Share
Download PDF
More article options
Visits
1461
Vol. 89. Issue 4.
(July - August 2023)
Case report
Full text access
Thyroid metastasis from cervical carcinoma
Visits
1461
Shuto Hayashia,b, Takumi Kumaib,c,
Corresponding author
t-kumai@asahikawa-med.ac.jp

Corresponding author.
, Tomohiko Michizukaa, Takashi Osakia
a Nikko Kinen Hospital, Department of Otorhinolaryngology, Hokkaido, Japan
b Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Hokkaido, Japan
c Asahikawa Medical University, Department of Innovative Head & Neck Cancer Research and Treatment (IHNCRT), Hokkaido, Japan
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Tables (1)
Table 1. Reported cases of metastatic cervical carcinoma to the thyroid gland.
Full Text
Introduction

Metastases to the thyroid gland have been reported in 1.4%–3% of patients who have undergone thyroidectomy for malignancy1. The most common sites of primary tumors that metastasize to the thyroid are the kidneys (25%), lungs (22%), gastrointestinal tract (13%), and breast (13%)2. Cervical carcinomas frequently metastasize to the lungs (21%), bone (16%), para-aortic lymph nodes (11%), abdominal cavity (8%), and supraclavicular lymph nodes (7%); however, primary gynecological malignancies rarely metastasize to the thyroid gland. This article describes a rare case of cervical squamous cell carcinoma that metastasized to the thyroid gland.

Case presentation

A 69-year-old woman presented to our department with a 2-month history of progressive swelling in the right anterior neck. Sixteen years ago, the patient had undergone a left hemithyroidectomy for a benign thyroid tumor at another hospital, which resulted in persistent paralysis of the left recurrent laryngeal nerve. Further, she had undergone hysterectomy followed by chemoradiotherapy for cervical squamous cell carcinoma 5 years before admission. The patient refused further examination and treatment for the cervical cancer.

Physical examination revealed a hard nodule with a diameter of 5cm in the right anterior cervical lesion. A laryngeal fiberscope revealed paralysis of the left, but not right larynx. Contrast-enhanced Computed Tomography (CT) revealed an irregular calcified tumor in the right thyroid gland and swollen lymph nodes in the bilateral neck (Fig. 1 A–C). Magnetic resonance imaging revealed a right thyroid tumor with low signal intensity on T1-weighted images and iso-signal intensity on T2-weighted images; moreover, the tumor showed heterogeneous staining with gadolinium (Fig. 1 D–F). Fluorodeoxyglucose Positron Emission Tomography/CT (FDG-PET/CT) showed abnormal FDG accumulation in the right thyroid gland, bilateral neck lymph nodes, and right iliac bone (Fig. 1 G–H). Fine Needle Aspiration Cytology (FNAC) of the thyroid revealed atypical epithelial cells with a high nuclear/cell ratio and hyperchromatic nuclei, which resembled cervical cancer cells.

Figure 1.

CT, MRI, and FDG-PET/CT images. (A–C) Contrast-enhanced Computed Tomography (CT) image showing a shadow with irregular margins and calcification in the right thyroid gland and swollen bilateral lymph nodes. (D‒F) Magnetic Resonance Imaging (MRI) showing a right thyroid tumor with low signal intensity on T1-weighted images (D), iso-signal intensity on T2-weighted images (E), and heterogeneous strong enhancement by gadolinium (F). (G‒H) Fluorodeoxyglucose Positron Emission Tomography/CT (FDG-PET/CT) image showing abnormal FDG accumulation in the right thyroid gland, bilateral cervical lymph nodes, and right iliac bone.

(0.71MB).

Given the risk of airway obstruction and dysphagia, the patient underwent tracheostomy and right hemithyroidectomy. A right neck dissection was simultaneously performed due to adherence of the thyroid tumor to the cervical lymph nodes. Under general anesthesia, a J-shaped skin incision was made from the right mastoid process to the anterior neck. The sternocleidomastoid muscle and internal jugular veins were resected due to tumor invasion. The thyroid tumor invaded the trachea and esophagus, which were both preserved following their surface resection. Pathological examination revealed normal thyroid tissue with squamous cell carcinoma (Fig. 2 A–B). Since the atypical epithelial cells were positive for p16, which is a surrogate marker of Human Papillomavirus (HPV), the patient was diagnosed with thyroid metastasis from cervical cancer (Fig. 2C). The patient has remained alive without any symptom for 5 postoperative months.

Figure 2.

Pathological findings. (A) Normal thyroid tissue (arrowhead) with atypical epithelial cell proliferation (arrow). (B) Atypical cells with oval nuclei, uneven chromatin aggregation, and multiple fissions (arrowheads). (C) Atypical cells expressed p16.

(0.88MB).
Discussion

Cervical cancer is related to HPV and expresses p16 as a surrogate marker for HPV infection. Our patient had a history of cervical cancer and did not present with other HPV-related cancers, including oropharyngeal cancer. Since histological examination revealed squamous cell carcinoma with p16 staining, the patient was diagnosed with thyroid metastasis from cervical cancer.

Metastasis of cervical cancer to the thyroid gland is rare, with only 14 cases having been reported, including our case (Table 1)3–14. The mean age of the reported patients was 55 years (range: 36–72 years; n=14). The histology of cervical cancer was squamous cell carcinoma in nine cases, adenocarcinoma in two cases, neuroendocrine carcinoma in two cases, and poorly differentiated carcinoma in one case. Moreover, the laterality of the thyroid tumor was bilateral, right, and left in one, six, and four patients, respectively. The median latency between the initial diagnosis of cervical cancer and its metastases to the thyroid gland was 15 months (range: 5–12 years; n=12). FNAC was performed in nine cases; among them, seven cases were considered positive for malignant cells. Thyroidectomy was performed in seven patients to preserve their quality of life. Distant metastasis other than thyroid tumors occurred in 10 out of the 14 patients (71%); among them, eight patients died within a year due to multiorgan metastasis.

Table 1.

Reported cases of metastatic cervical carcinoma to the thyroid gland.

Case  Year  Author  Age  Histology  Side  Distant metastasis  Latency period  FNAC  Treatment  Progress 
1977  Martino et al.4  39  SCC  Lt  Lung  2 years  NS  PCO  DOD (4 months) 
2000  Cheyng et al.5  57  AC  Bil  None  1year  NS  TT+RT  NS 
2002  Singh et al.6  38  NC  Rt  Liver, lung  1year  SOM  CT  DOD (6 months) 
2005  Kim et al.7  42  SCC  NS  None  6 years  SOM  PCO  DOD (4 months) 
〃  〃  53  SCC  NS  Pancreas  1.5 years  ND  PCO  DOD (6 months) 
2006  Karapanagiotou et al.8  68  SCC  Rt  Lung  4 years  ND  CT+RT  DOD (4 months) 
2013  Vamsy et al.9  68  SCC  Lt  Bone, liver, lung  12 years  SOM  TT+RND+CRT  NS 
2015  Fuentes-Martinez et al.10  36  PDC  Rt  Kidney  1year  SOM  CRT  DOD (6 months) 
2016  Celik et al.11  56  SCC  Rt  Bone, lung  6 months  NS  TT+CNLND  DOD (5 months) 
10  2019  Varli et al.12  55  SCC  NS  None  5 months  NS  TT+CT+RT  NS 
11  2021  Bertone F et al.13  72  AC  Rt  None  NS  SOM  HT+CT  AWD (6 months) 
12  2021  Ravindrakumar et al.14  56  SCC  Lt  Bone  NS  SOM  CRT  NS 
13  2022  Li et al.[15]  54  NC  Lt  Bone  3 years  NS  HT+CNLND+CT  DOD (1year) 
14  2022  Present case  69  SCC  Rt  Bone  5 years  SOM  HT+RND  AWD (5 months) 

AC, Adenocarcinoma; AWD, Alive With Disease; Bil, Bilateral; CNLND, Central Neck Lymph Node Dissection; CRT, Chemoradiotherapy; CT, Chemotherapy; DOD, Died of Disease; HT, Hemithyroidectomy; Lt, Left; NC, Neuroendocrine Carcinoma; ND, No Diagnosis; NS, Not Stated; PCO, Palliative Care Only; PDC, Poorly Differentiated Carcinoma; RND, Radical Neck Dissection; Rt, Right; RT, Radiotherapy; SCC, Squamous Cell Carcinoma; SOM, Suspicion Of Metastasis; TT, Total Thyroidectomy.

Since thyroid tumors can obstruct the airway and digestive tract, it is important to carefully treat metastasis to the head and neck region. Since there are no international guidelines for the management of thyroid metastases from cervical cancer, individualized treatment interventions including tracheostomy and surgical resection should be considered to relieve symptoms and improve quality of life. Since our patient had left recurrent laryngeal nerve paralysis and thyroid tumor invasion near the right recurrent laryngeal nerve, a tracheostomy was performed to secure the airway. Additionally, thyroidectomy and neck dissection were performed to preserve swallowing function by releasing the esophagus from the adhered tumor. Although these surgeries are not curative treatments for cervical cancer with multiple metastases, palliative tumor reduction could improve the quality of life.

Conclusion

This article reports a rare case of thyroid metastasis from cervical carcinoma. Although the prognosis of cervical cancer with metastasis is generally poor, surgical resection may be useful for securing the airway and digestive tract in order to temporarily improve the quality of life of patients with metastatic thyroid cancer.

Funding

The authors received no financial support for the publication of this article.

Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
A.Y. Chung, T.B. Tran, K.T. Brumund, R.A. Weisman, M. Bouvet.
Metastases to the thyroid: a review of the literature from the last decade.
Thyroid, 22 (2012), pp. 258-268
[2]
I.J. Nixon, A. Coca-Pelaz, A.I. Kaleva, A. Triantafyllou, P. Angelos, R.P. Owen, et al.
Metastasis to the thyroid gland: a critical review.
Ann Surg Oncol, 24 (2017), pp. 1533-1539
[3]
E. Karapanagiotou, M.W. Saif, D. Rondoyianni, S. Markaki, C. Alamara, M. Kiagia, et al.
Metastatic cervical carcinoma to the thyroid gland: a case report and review of the literature.
Yale J Biol Med, 79 (2006), pp. 165-168
[4]
E. Martino, G. Bevilacqua, M. Nardi, E. Macchia, A. Pinchera.
Metastatic cervical carcinoma presenting as primary thyroid cancer. Case report.
[5]
A.Y. Cheung, L. Donner, C. Capen.
Metastatic adenocarcinoma of the uterine cervix to the thyroid gland.
Clin Oncol (R Coll Radiol), 12 (2000), pp. 60-61
[6]
R. Singh, M. Bibbo, M.F. Cunnane, J.A. Carlson, A.E. de Papp.
Metastatic cervical carcinoma with ectopic calcitonin production presenting as a thyroid mass.
Endocr Pract, 8 (2002), pp. 50-53
[7]
T.Y. Kim, W.B. Kim, G. Gong, S.J. Hong, Y.K. Shong.
Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy.
Clin Endocrinol (Oxf), 62 (2005), pp. 236-241
[8]
M. Vamsy, P.S. Dattatreya, L.Y. Sarma, M. Dayal, N. Janardhan, V.V. Rao.
Metastatic squamous cell carcinoma thyroid from functionally cured cancer cervix.
Indian J Nucl Med, 28 (2013), pp. 112-114
[9]
N. Fuentes-Martínez, J. Santos Juanes, B. Vivanco-Allende, S.G. Gagatek.
Thyroid nodule as a first sign of progression in uterine cervical carcinoma.
Acta Otorrinolaringol Esp, 66 (2015), pp. 353-355
[10]
S.U. Celik, D. Besli, S.D. Sak, V. Genc.
Thyroid gland metastasis from cancer of the uterine cervix: an extremely rare case report.
Acta Med (Hradec Králové), 59 (2016), pp. 97-99
[11]
B. Varlı, S. Taşkın, F. Ortaç.
Metastatic cervical carcinoma to the thyroid gland: a rare diagnosis.
Taiwan J Obstet Gynecol, 58 (2019), pp. 298-299
[12]
F. Bertone, E. Serusi, D.S. Liscia, E. Biletta, C.F. Gervasio.
Thyroid gland metastasis from endometrial carcinoma causing acute severe dyspnea.
Ear Nose Throat J, 0 (2021),
[13]
S. Ravindrakumar, N. Thalahitiyage, N. Harivallavan, U. Jayarajah, V.S.D. Rodrigo.
Squamous cell carcinoma of the uterine cervix metastasizing to the thyroid gland: a case report.
Surg Case Rep, 7 (2021), pp. 255
[14]
S. Li, J. Tang, J. Wang, X. Liu, Y. Zhou, P. Gu.
Metastasis of mixed adenoneuroendocrine carcinoma of the uterine cervix to thyroid gland.
Ear Nose Throat J, (2022),
Copyright © 2023. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial
Idiomas
Brazilian Journal of Otorhinolaryngology (English Edition)
Article options
Tools
en pt
Announcement Nota importante
Articles submitted as of May 1, 2022, which are accepted for publication will be subject to a fee (Article Publishing Charge, APC) payment by the author or research funder to cover the costs associated with publication. By submitting the manuscript to this journal, the authors agree to these terms. All manuscripts must be submitted in English.. Os artigos submetidos a partir de 1º de maio de 2022, que forem aceitos para publicação estarão sujeitos a uma taxa (Article Publishing Charge, APC) a ser paga pelo autor para cobrir os custos associados à publicação. Ao submeterem o manuscrito a esta revista, os autores concordam com esses termos. Todos os manuscritos devem ser submetidos em inglês.