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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 430-431
Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology


Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India

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   Abstract 

In April 2006, a 55-year-old female presented with a thyroid mass and multiple skin nodules on scalp, forehead and neck. Fine needle aspiration cytology of thyroid mass and multiple skin nodules show tumor cells clusters in a repetitive microfollicular pattern on May-Grunwald-Giemsa stain suggestive of follicular thyroid carcinoma with metastasis to skin. Although follicular carcinoma have a propensity for vascular invasion and hematogenous dissemination, skin is not commonly involved. Only a few cases of cutaneous metastasis from follicular thyroid carcinoma are reported in the English language literature.

Keywords: Follicular carcinoma, metastasis, microfollicular pattern

How to cite this article:
Agarwal S, Rao S, Arya A, Gupta K, Arora R, Dhawan I. Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology. Indian J Pathol Microbiol 2008;51:430-1

How to cite this URL:
Agarwal S, Rao S, Arya A, Gupta K, Arora R, Dhawan I. Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Dec 11];51:430-1. Available from: http://www.ijpmonline.org/text.asp?2008/51/3/430/42552



   Introduction Top


Well-differentiated follicular thyroid carcinoma is composed of normal-looking thyroid follicles with or without mild anaplasia. Diagnosis depends mainly on vascular or capsular invasion. [1] When such invasion is failed to be detected, the first evidence of malignant follicular tumor may be appearance of distant metastasis generally to bone and lungs. [1] Cutaneous metastasis from follicular thyroid carcinoma is rare and fine needle aspiration (FNA) is an important method for rapid diagnosis of such lesions.


   Case history Top


In April 2006, a 55-year-old female presented with enlarged thyroid gland and multiple skin nodules on scalp, forehead and neck. According to the patient, thyroid swelling was present for more than 10 years and skin nodules developed 2-3 months back. Clinically, thyroid swelling was diagnosed as goiter.

Subcutaneous nodules were soft to firm and not painful. Clinically, nodules were diagnosed as epidermal inclusion cysts [Figure 1].

Pathological findings

Fine needle aspiration from thyroid mass shows cellular smears with many uniform-sized epithelial cell clusters forming microfollicles or rosettes in a repetitive manner. Nuclei show mild anisokaryosis. FNA smears from skin nodules also showed same cytological features [Figure 2].


   Discussion Top


Follicular carcinoma accounts for 10-20% of all thyroid cancers. They tend to present in women with peak incidence in 40-50 years. Incidence of follicular carcinoma is increased in areas of dietary iodine deficiency, suggesting that nodular goiter may predispose to the development of the neoplasm. [2]

Our case presented with thyroid mass of long duration, which was clinically diagnosed as adenomatous goiter and multiple skin nodules developing recently were considered epidermal inclusion cyst. However, cytology smears from thyroid mass as well as skin nodules show epithelial cell clusters forming microfollicles/rosettes in a repetitive manner consistent with well-differentiated follicular thyroid carcinoma with metastasis to skin. [3]

Although follicular carcinomas have a propensity for vascular invasion and hematogenous dissemination, skin is not commonly involved. The overall rarity of cutaneous metastasis from follicular thyroid carcinoma is reflected by the presence of only 15 such cases previously reported in English language literature.[4],[5]

However, only one case of diagnosis of skin metastasis from follicular thyroid carcinoma by fine needle aspiration cytology (FNAC) has been reported. [6]

Our report adds to the literature one more case of cutaneous metastasis from follicular thyroid carcinoma that was diagnosed by FNAC.

 
   References Top

1.Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am 1995;24:761-802.  Back to cited text no. 1  [PUBMED]  
2.Maitra A, Abbas AK. The endocrine system. In : Kumar V, Abbas AK, Fausto N, editors. Robbins and Cotran pathologic basis of disease. 7 th ed. New Delhi: Harcourt India Private Ltd; 2003. p. 1155-226.  Back to cited text no. 2    
3.Rico MJ, Penneys NS. Metastatic follicular carcinoma of the thyroid to the skin: A case confirmed by immunohistochemistry. J Cutan Pathol 1985;12:103-5.  Back to cited text no. 3    
4.Dhal PR, Brodland DG, Goellnar JR, Hay ID. Thyroid carcinoma metastatic to the skin: A cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol 1997;36:531-7.  Back to cited text no. 4    
5.Quin TR, Duncan LM, Zembowicz A, Faquin WC. Cutaneous metastasis of follicular thyroid carcinoma: A report of four cases and a review of literature. Am J Dermatopathol 2005;27:306-12.  Back to cited text no. 5    
6.Kumar PV, Monabati A, Tabei SZ, Ramzy M, Husseini SV, Khajeh F. Metastatic follicular thyroid carcinoma diagnosed by fine needle aspiration cytology: A report of 3 cases. Acta Cytol 2005;49:177-80.  Back to cited text no. 6  [PUBMED]  

Top
Correspondence Address:
Shweta Agarwal
C1/2807 (G.F.), Sushant Lok-1, Gurgaon - 122 002, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42552

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    Figures

  [Figure 1], [Figure 2]

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    Abstract
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