A Unique Case of Intranasal Metastasis from Occult Poorly Differentiated Thyroid Carcinoma

Yıl 2015, Cilt: 32 Sayı: 3, 316 - 319, 01.07.2015

Rauf Oğuzhan Kum Erdinç Aygenç Battal Tahsin Somuk Pelin Börcek Cafer Özdem

Öz

_Poorly differentiated thyroid carcinomas (PDTCs) lie, both morphologically and behaviorally, between well-differentiated and undifferentiated carcinomas. Metastasis of poorly differentiated thyroid carcinoma to the intranasal cavity has not been reported previously in the literature. Case Report_ A 48-year-old male patient presented with massive epistaxis and nasal obstruction. On nasal examination, a bleeding, vascular mass was seen filling the left nasal cavity. The histopathological report of the nasal mass was well-differentiated thyroid carcinoma metastasis. Whole body scintigraphy, ultrasonography and positron emission tomography were done to rule out other possible metastases in the body and determine the origin of the tumor, which was identified as the left lobe of the thyroid gland, and there were multiple metastases involving the lung, sacroiliac area, and left humerus. Histopathological examination of a thyroidectomy specimen revealed PDTC consisting of insular, follicular, and papillary components. Postoperatively, the patient received radioactive iodine ablation therapy (iodine-131) and a course of external beam radiation therapy to the sacroiliac area and other metastatic regions. No recurrences were observed in a follow-up period of 5 years after surgery. Conclusion_ The metastasis of differentiated thyroid carcinoma as a component of PDTC to the intranasal cavity has not been reported before. It is interesting that the well-differentiated component of the tumor was metastasized in our patient. Due to the aggressiveness of PDTC and the poor survival rates in patients who undergo surgery alone, a multidisciplinary treatment approach is required_

Anahtar Kelimeler

Metastasis, nasal cavity, papillary thyroid carcinoma, thyroid neoplasm

Kaynakça

• 1. Rocha AS, Soares P, Fonseca E, Cameselle-Teijeiro J, Oliveira MC, Sobrinho-Simoes M. E-cadherin loss rather than betacatenin alterations is a common feature of poorly differentiated thyroid carcinomas. Histopathology 2003;42:580-7. [CrossRef]
• 2. Langhans T. Über die epithelialen Formen der malignen Struma. Virchows Archive 1907;189:69-152. [CrossRef]
• 3. Sakamoto A, Kasai N, Sugano H. Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a highrisk group of papillary and follicular carcinomas. Cancer 1983;52:1849-55. [CrossRef]
• 4. Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, et al. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 2007;31:1256- 64. [CrossRef]
• 5. Bernstein JM, Montgomery WW, Balogh K, Jr. Metastatic tumors to the maxilla, nose, and paranasal sinuses. Laryngoscope 1966;76:621-50. [CrossRef]
• 6. Lam KY, Lo CY, Chan KW, Wan KY. Insular and anaplastic carcinoma of the thyroid: a 45-year comparative study at a single institution and a review of the significance of p53 and p21. Ann Surg 2000;231:329-38. [CrossRef]
• 7. Sanders EM, Jr., LiVolsi VA, Brierley J, Shin J, Randolph GW. An evidence-based review of poorly differentiated thyroid cancer. World J Surg 2007;31:934-45. [CrossRef]
• 8. Sabih Q, Spafford MF, Dietl CA. Poorly differentiated thyroid carcinoma with sternal invasion. A case report and review of the literature. Int J Surg Case Rep 2014;5:816-20. [CrossRef]
• 9. Altman KW, Mirza N, Philippe L. Metastatic follicular thyroid carcinoma to the paranasal sinuses: a case report and review. J Laryngol Otol 1997;111:647-51. [CrossRef]
• 10. Duque-Fisher CS, Casiano R, Velez-Hoyos A, Londono-Bustamente AF. [Metastasis to the sinonasal region]. Acta Otorrinolaringol Esp 2009;60:428-31.[CrossRef