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    -  Kępiński M
    -  Drozdzowska B

 
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Follicular variant of papillary thyroid carcinoma with metastasis to the kidney


1 Department and Chair of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
2 Clinic of Urology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland

Date of Submission16-May-2020
Date of Decision19-Jul-2020
Date of Acceptance22-Aug-2020
Date of Web Publication24-Nov-2020

Correspondence Address:
Magdalena Chrabanska,
Department and Chair of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice
Poland
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijc.IJC_514_20

PMID: 33402592




How to cite this URL:
Chrabanska M, Kępiński M, Drozdzowska B. Follicular variant of papillary thyroid carcinoma with metastasis to the kidney. Indian J Cancer [Epub ahead of print] [cited 2021 Jul 29]. Available from: https://www.indianjcancer.com/preprintarticle.asp?id=301405




Follicular variant of papillary thyroid carcinoma (FV-PTC) is the second most common subtype of PTC. The main pattern of the spread of PTC is to the cervical lymph nodes, with distant metastases occurring uncommonly.[1] The major sites of distant metastases are the lungs and bones, while clinically detectable renal metastases are extremely rare.[2],[3]

We report a case of FV-PTC with renal metastasis in the patient with widely disseminated disease.

FV-PTC in a 50-year-old woman was initially presented as a metastatic bone disease 9 years ago. Subsequently, multiple bone metastases have developed at various intervals during the entire span of 9 years. 3 months ago, computed tomography of the abdomen and pelvis revealed a tumor mass measuring 6.5 × 5 × 4 cm projecting outward from the upper pole of the right kidney that raised suspicions of primary renal cell carcinoma [Figure 1]a and [Figure 1]b. A right-sided radical nephrectomy was performed. Gross examination of the kidney revealed a well-circumscribed, solid, gray-tan tumor [Figure 1]c. Microscopic examination offered a differential diagnosis of metastatic deposits from thyroid malignancy or a primary thyroid-like follicular carcinoma of the kidney [Figure 2] and [Figure 3]. Immunohistochemically, neoplastic cells showed positive staining for cytokeratin 7, thyroid transcription factor-1, cytokeratin 19, galectin-3, and human bone marrow endothelium marker-1 [Figure 4] Hence, the histological and immunohistochemical findings supported the diagnosis of metastatic FV-PTC to the kidney. Currently, the patient is qualified for the delivery of treatment with an investigational tyrosine kinase inhibitor (sorafenib).
Figure 1: Radiologic and macroscopic findings of metastatic follicular variant of papillary thyroid carcinoma to the right kidney: (a and b) An axial abdominal computed tomography scans revealing tumor projecting outward from the upper pole of right kidney, (c) Gross picture of the radical nephrectomy specimen showing a well-circumscribed, solid, gray-tan tumor

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Figure 2: Microscopic findings of metastatic follicular variant of papillary thyroid carcinoma to the kidney: (a) The border between tumor (left) and surrounding renal parenchyma (right) (H and E, original magnification ×4), (b) The tumor shows the follicular architecture and lacks classic papillary morphology (H and E, original magnification ×10)

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Figure 3: Nuclear features of follicular variant of metastatic papillary thyroid carcinoma: (a) Nuclear overlapping, nuclear enlargement, and nuclear grooves (H and E, original magnification ×40), (b) Ground glass nuclei (arrow) and nuclear crowding (H and E, original magnification ×40)

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Figure 4: Immunohistochemical findings of metastatic follicular variant of papillary thyroid carcinoma to the kidney - tumor cells show positivity for (a) cytokeratin 7 (original magnification ×100), (b) galectin-3 (original magnification ×100), (c) thyroid transcription factor-1 (original magnification ×40), (d) human bone marrow endothelium marker-1 (original magnification ×200)

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Distant metastases derived from PTC are infrequent, occurring in 3.5–3.8% of patients.[4] Metastases from FV-PTC can occur at any time during the course of the disease, however, the initial presentation of metastatic disease has been reported in only 2% of cases.[1],[5] Metastases to the kidney from PTC are found in only 2.8–3.8% of cases.[5] The occurrence of renal tumors originating from thyroid cancer is extraordinary with a prevalence of 0.47%.[5] To the best of our knowledge, 14 cases of renal metastasis from FV-PTC have been reported in the literature.[1],[2],[3],[4],[5] The main differential diagnosis for the FV-PTC metastatic to the kidney is a primary thyroid-like follicular carcinoma of the kidney. Due to the rare occurrence of renal metastases from PTC, the best management for this condition is unclear.[5] Treatment options include surgery, radioiodine therapy, and tyrosine kinase inhibitor therapy.[1],[2],[3],[4],[5]

In conclusion, we report this case because of its rarity, and our hope is that this will be helpful for the diagnosis and treatment of renal metastasis from PTC in the future.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Falzarano SM, Chute DJ, Magi-Galluzzi C. Metastatic papillary thyroid carcinoma to the kidney: Report of two cases mimicking primary renal cell carcinoma and review of the literature. Pathology 2013;45:89-93.  Back to cited text no. 1
    
2.
Nair LM, Anila KR, Sreekumar A, Pradeep VM. Renal metastasis from papillary carcinoma thyroid detected by whole body iodine scan: A case report and review of the literature. Indian J Nucl Med 2016;31:232-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kadamkulam Syriac A, Mirza M, Malekunnel AR, Locante A, Desai P. Synchronous colon cancer with pulmonary metastasis and follicular variant of papillary thyroid cancer metastasising to kidney. BMJ Case Rep 2018;2018:bcr2018225922.  Back to cited text no. 3
    
4.
Gao Y, Deng W, Chen Y, Fan Y, Guo Z. Renal metastases as the initial presentation of papillary thyroid carcinoma: A case report and literature review. Mol Clin Oncol 2017;6:821-4.  Back to cited text no. 4
    
5.
Kulkarni P, Rekha PS, Prabhu M, Venkataramarao SH, Raju N, Chandrasekhar NH, et al. Renal metastasis and dual (18 F-Fluorodeoxyglucose and131 I) avid skeletal metastasis in a patient with papillary thyroid cancer. Indian J Nucl Med 2017;32:50-3.  Back to cited text no. 5
[PUBMED]  [Full text]  


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