Thyroid papillary carcinoma presenting with femoral neck metastasis: a case report

Authors

  • Birol Aktas Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
  • Mehmet Esat Uygur Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey
  • Mehmet Salih Soylemez Department of Orthopaedics and Traumatology, Bingol State Hospital, Bingol, Turkey http://orcid.org/0000-0002-0828-0145
  • Bahattin Kemah Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
  • Bilge Bilgic Department of Pathology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
  • Bahar Ceyran Department of Pathology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
  • Korhan Ozkan Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20163133

Keywords:

Papillary thyroid carcinoma, Bone metastasis, Solitary bone lesion

Abstract

Thyroid carcinoma is relatively uncommon, accounting for 2% of all cancers. Although they usually present as a neck lump, occasionally they may be presented with a distant metastasis. In this study, a 65 year-old woman was referred to our clinic with a pain on her left hip at both rest and walking. A lytic area at the inferior femoral neck was found with plain radiography. To clarify the characteristics of the lesion, left hip magnetic resonance imaging (MRI) had been performed displaying 3×5 cm hyperintense lesion extending from medial part of the left femoral neck to the left femoral head. Laboratory findings were normal. An open biopsy had then been performed from the left femoral neck with a suspicion of a metastatic tumor. After Immunohistochemical assesment diagnosis was consistent with metastatic thyroid papillary cancer. Proximal femoral resection with clear margins were achieved by proximal femur tumor endoprosthesis.  In conclusion, papillary thyroid cancer have an excellent prognosis and doesn’t tend to metastese. But rarely, as seen in our case it can even present with syptoms of metastasic disease. Management strategy is the same as other solitary bone metastasis. Papillary thyroid cancer must be kept in mind as a differential diagnosis in solitary bone metatasis.

Author Biographies

Birol Aktas, Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

Department of Orthopaedics and Traumatology

Mehmet Esat Uygur, Department of Orthopaedics and Traumatology, Emsey Hospital, Istanbul, Turkey

Department of  Orthopaedics and Traumatology,

Mehmet Salih Soylemez, Department of Orthopaedics and Traumatology, Bingol State Hospital, Bingol, Turkey

Department of Orthopaedics and Traumatology

Bahattin Kemah, Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

Department of Orthopaedics and Traumatology,

Bilge Bilgic, Department of Pathology, Istanbul University, Faculty of Medicine, Istanbul, Turkey

Department of Pathology

Bahar Ceyran, Department of Pathology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

Department of Pathology,

Korhan Ozkan, Department of Orthopaedics and Traumatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

Department of Orthopaedics and Traumatology

References

Lai S, Susan Y, Mandel J, Weber RS. Disorders of the Thyroid Gland. In: Cummings CW, Haughey BH, Thomas JR, Harker LA, Robins K, Flint PW, Schuller D, Cummings R, editors, Otolaryngology: Head and Neck Surgery. Inc:Philadelphia, PA Mosby Pub; 2005: 1735-1750.

Shoup M, Stojadinovic A, Nissan A, Ghossein RA, Freedman S, Brennan MF, et al. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. J Am Coll Surg. 2003;197(2):191-7.

Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma:benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91(8):2892-9.

Weber KL. Evaluation of the adult patient (aged> 40 years) with a destructive bone lesion. J Am Acad Orthop Surg. 2010;18(3):169-79.

Gimm O, Dralle H. Differentiated thyroid carcinoma. In: Holzheimer RG, Mannick JA editors. Surgical Treatment: Evidence-Based and Problem-Oriented, W. Zuckschwerdt Verlag Munchen; 2001.

Wu K, Hou SM, Huang TS, Yang RS. Thyroid carcinoma with bone metastases: a prognostic factor study. Clin Med Oncol. 2008;2:129-34.

Hindié E, Zanotti-Fregonara P, Keller I, Duron F, Devaux JY, Calzada-Nocaudie M, et al. Bone metastases of differentiated thyroid cancer: impact of early 131I-based detection on outcome. Endocrine-Related Cancer. 2007;14:799-807.

Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clinical endocrinology. 2014;81(1):1-122.

Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. European radiology. 2009;19(3):731-44.

Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. The Journal of Clinical Endocrinology & Metabolism. 2003;88(4):1433-41.

Kwee TC, Basu S, Cheng G, Alavi A. FDG PET/CT in carcinoma of unknown primary. European journal of nuclear medicine and molecular imaging. 2010;37(3):635-44.

Downloads

Published

2016-09-03