Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 47, Num. 4, 2010, pp. 479-480

Indian Journal of Cancer, Vol. 47, No. 4, October-December, 2010, pp. 479-480

Letter to Editor

An unusual site of distant metastasis in carcinoma of the thyroid

G Chaturvedy¹, R Kumar¹, K Sikka¹, CV Karthikeyan¹, SR Mathur²

¹ Department of Otolaryngology Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
² Department of Pathology, All India Institute of Medical Sciences, New Delhi-110029, India

Correspondence Address:
R Kumar
Department of Otolaryngology Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi-110029
India
winirk@hotmail.com

Code Number: cn10116

PMID: 21131772

DOI: 10.4103/0019-509X.73560

Sir,

Although follicular thyroid cancer is notorious for distant metastasis, a unique case of metastasis of this tumor in the upper lip is discussed here.

A 68-year-old man presented with an upper lip swelling of 4 months duration. The swelling was gradually increasing and painless. Except for cosmetic disfigurement, the patient did not have any other complaint.

Four years back, the patient had undergone a total thyroidectomy for large follicular carcinoma of thyroid. The surgery and postoperative course had been uneventful. He had received 100 mCi I-131 and was on oral eltroxin and was euthyroid. The patient was on regular follow-up, and there was no evidence of disease locoregionally.

Examination revealed 4 Χ 4 cm firm, nontender swelling involving the upper lip. There was no other palpable swelling in the neck, and he was found to be normal on general physical and systemic examination. Fine-needle aspiration cytology from the lip swelling revealed a tumor showing repetitive microfollicular pattern. The slide of his thyroid specimen also showed similar findings. There was a strong suspicion of follicular carcinoma; and therefore, excision biopsy was advised for confirmation. ¹⁸F-fluorodeoxyglucose positron emission tomography and computed tomography scan were done and it revealed increased uptake in upper lip buccal surface. Rest of the areas showed no evidence of distant metastasis. Serum thyroglobulin was elevated to 109 ng/mL (max normal 52.0). The excisional biopsy under monitored local anesthesia was done. Histopathology confirmed it to be a metastasis from follicular carcinoma thyroid [Figure - 1].

The case is being discussed in view of rarity of clinical presentation and behavior of common thyroid tumor. In Medline search of last 10 years, we do not find any reported case of follicular carcinoma metastasizing to upper lip in literature in English. The unusual sites, such as scalp skin, skeletal muscle, paranasal sinuses, and submandibular gland, however, find a mention as metastatic sites from thyroid cancer.^[1],[2],[3] The patient already having received radioiodine and having surgically accessible site of metastasis, surgical excision seemed a good management option, considering fair prognosis in metastatic thyroid tumors.^[4]

References

1.	Chakraborty J, Bandyopadhyay A, Choudhuri MK, Mitra K, Guha D, Mallik MG. Cutaneous metastasis from follicular variant of papillary thyroid carcinoma: A case diagnosed on cytology. Indian J Pathol Microbiol 2008;51:91-3.  Back to cited text no. 1  [PUBMED]
2.	Panoussopoulos D, Theodoropoulos G, Vlahos K, Lazaris AC, Papadimitriou K. Distant solitary skeletal muscle metastasis from papillary thyroid carcinoma. Int Surg 2007;92:226-9.  Back to cited text no. 2
3.	Sarda AK, Pandey D, Bhalla SA, Goyal A. Isolated submandibular gland metastasis from an occult papillary thyroid cancer. Indian J Cancer 2004;41:89-91.  Back to cited text no. 3  [PUBMED]
4.	Zettinig G, Fueger BJ, Passler C, Kaserer K, Pirich C, Dudczak R, et al. Long-term follow-up of patients with bone metastases from differentiated thyroid carcinoma-surgery or conventional therapy? Clin Endocrinol (Oxf) 2002;56:377-82.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]

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