Thyroid gland
Other carcinoma
Metastases to thyroid gland

Author: Shuanzeng Wei, M.D., Ph.D. (see Authors page)

Revised: 1 August 2017, last major update June 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: metastases thyroid gland

Cite this page: Metastases to thyroid gland. PathologyOutlines.com website. http://pathologyoutlines.com/topic/thyroidmetastatic.html. Accessed August 24th, 2017.
Definition / general
  • 3% of thyroid malignancies are metastases (Cancer 1997;79:574)
  • Direct extension common from tumors of pharynx, larynx, trachea, esophagus and neck - usually are squamous cell carcinomas
  • Metastases are found at autopsy in thyroid in up to 25% of patients dying of disseminated malignancies
  • FNA useful for diagnosis of solitary metastases (Cytojournal 2007;4:5)
Essential features
  • The most common metastases include: direction extension of squamous cell carcinoma and distant metastases from kidney, lung, head and neck
Epidemiology
Diagnosis
  • Fine needle aspiration
Clinical features
  • Most common primary sites are kidney, lung, head and neck, breast (Am J Clin Oncol 2015;38:338)
  • Metastases from kidney are generally solitary, occurring a mean 9.4 years after nephrectomy; 36% of the time, metastasis to thyroid was initial presentation of renal cell carcinoma (Cancer 2002;95:1869)
Radiology images

Images hosted on other servers:

Metastatic renal cell carcinoma

CT scan

Prognostic factors
  • Determined by the underlying primary tumor
  • Median survival: 20 months
    • Patients who undergo thyroid resection: 30 months
    • Without thyroid surgery: 12 months
Case reports
Treatment
Gross images

Images hosted on PathOut server:

Melanoma metastatic from skin primary (AFIP)

Metastatic renal cell carcinoma, contributed by Dr. Mark R. Wick



Images hosted on other servers:

Invasion by squamous cell carcinoma of larynx

Renal papillary carcinoma

Microscopic (histologic) description
  • May involve multiple areas of thyroid gland
  • Can be small deposits within lymphovascular spaces or large mass
Microscopic (histologic) images

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Images hosted on PathOut server:

Breast carcinoma, AFIP images:

Lobular carcinoma and entrapped thyroid follicles

ER stains breast tumor but not papillary carcinoma

Falsely positive thyroglobulin staining



Kidney: renal cell carcinoma:

Metastatic renal cell carcinoma, contributed by Dr. Mark R. Wick

Clear cell type

Cytoplasm is abundant and completely clear

Oil Red O stains cytoplasm strongly

False positive thyroglobulin staining

Contributed by Dr. Mark R. Wick: CD10, Keratin 8, RCC, thyroglobulin



Lung, AFIP images:

Carcinoid tumor with well defined nesting pattern

Carcinoma metastatic to mediastinal thyroid gland



Other:

Melanoma

Metastatic follicular
carcinoma in bone, TTF1 stain,
contributed by Dr. Mark R. Wick



Uterus:

Case of the Week #342: metastatic leiomyosarcoma (frozen section slides)

Case of the Week #342: metastatic leiomyosarcoma (permanent sections)



Images hosted on other servers:

H&E Low power

Metastatic HCC in the thyroid gland

Positive staining for alpha-fetoprotein

Metastatic breast carcinoma



Kidney: renal cell carcinoma metastatic to thyroid:

Clear cell type

Metastasis to goiter

Concurrent RCC and thyroid carcinoma

   

Central lesions inside
hyperplastic adenomatoid
nodules

FNA, histology and stains

CD10 and H&E



Other:

Lung-small cell carcinoma

Lung-squamous cell carcinoma

Melanoma

Parotid adenoid cystic carcinoma

Rectal carcinoma
to poorly differentiated
thyroid carcinoma



Cytology images

Images hosted on PathOut server

FNA: metastatic renal cell carcinoma, contributed by Dr. Mark R. Wick



Images hosted on other servers:

Esophageal squamous cell carcinoma

Kidney: metastatic renal cell carcinoma, clear cell type

Kidney: bloody background with clusters of atypical cells; nuclei are somewhat pleomorphic with prominent nucleoli

Lung squamous cell carcinoma


Melanoma

Melanoma - HMB45

Parotid gland adenoid cystic carcinoma

Positive stains
  • Mucin+ in metastatic adenocarcinoma, which is not seen in primary thyroid tumor
  • Primary tumor specific markers
Negative stains
  • Thyroglobulin (may be spuriously positive due to the permeating colloid), TTF1 (excluding lung or small cell carcinoma)
Differential diagnosis
Board review question #1
Which statement is False for metastatic clear cell renal cell carcinoma to the thyroid?

  1. Metastasis from renal cell carcinoma is generally a solitary mass.
  2. Metastatic clear cell renal cell carcinoma can have a very long latency after nephrectomy.
  3. Metastatic clear cell renal cell carcinoma can have a spurious thyroglobulin stain.
  4. TTF1 and PAX8 can be used to differentiate tumors of renal and thyroid origins.
  5. Metastatic tumor to the thyroid gland is the initial manifestation of renal cell carcinoma in 1/3 of cases.
Board review answer #1
D. TTF1 and PAX8 can be used to differentiate renal and thyroid origins.

Explanation: tumors from both thyroid and kidney can be positive for PAX8.