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  Table of Contents    
LETTERS TO EDITOR  
Year : 2017  |  Volume : 60  |  Issue : 2  |  Page : 298-299
Fine needle aspiration cytology of thyroid metastasis: An unusual presentation of cervical carcinoma; a case report and review of literature


Department of Pathology, Post Graduate Institute of Medical Education and Research, Dr. RML Hospital, New Delhi, India

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Date of Web Publication19-Jun-2017
 

How to cite this article:
Singh M, Gupta P, Bhardwaj M. Fine needle aspiration cytology of thyroid metastasis: An unusual presentation of cervical carcinoma; a case report and review of literature. Indian J Pathol Microbiol 2017;60:298-9

How to cite this URL:
Singh M, Gupta P, Bhardwaj M. Fine needle aspiration cytology of thyroid metastasis: An unusual presentation of cervical carcinoma; a case report and review of literature. Indian J Pathol Microbiol [serial online] 2017 [cited 2020 Apr 4];60:298-9. Available from: http://www.ijpmonline.org/text.asp?2017/60/2/298/208398


Editor,

Metastatic involvement of thyroid is uncommon and constitutes only 1% of all thyroid malignancies.[1] We report a rare case of clinically occult squamous cell carcinoma (SCC) of cervix presenting as metastatic thyroid deposit and generalized lymphadenopathy.

A 28-year-old female patient presented with breathlessness, weight loss, generalized lymphadenopathy, and thyroid swelling for the past 2 months. The lymph nodes varied in size from 1 to 2 cm and thyroid swelling was nodular, right-sided measured 2 cm × 2 cm. Chest X-ray revealed homogeneous haziness over the right lung fields with blunted costophrenic angle. Ultrasonography of neck revealed multiple enlarged cervical lymph nodes and a well-defined hypoechoic lesion, 18 mm × 16 mm in the right lobe of thyroid with central vascularity.

Clinically, a provisional diagnosis of thyroid malignancy with metastasis was considered. Fine needle aspiration (FNA) was done from both the thyroid swelling and the lymph nodes from which direct smears and cell block were made. The smears were stained with Papanicolaou (PAP) and Giemsa stains. Thyroid swelling and lymph node smears showed malignant epithelial cells arranged in sheets, clusters, and few singly scattered. The cells revealed moderate pleomorphism, coarse granular nuclear chromatin, prominent nucleoli, and moderate amount of cytoplasm [Figure 1]a. Few clusters of benign follicular epithelial cells were also noted. Background had inflammatory cells and areas of necrosis. Cytomorphologically, a differential diagnosis of metastatic SCC versus anaplastic carcinoma thyroid with squamoid features was considered.
Figure 1: (a) Sheet of malignant epithelial cells in fine needle aspiration smear from thyroid swelling revealing moderate pleomorphism, polygonal cells, coarse granular chromatin, and moderate cytoplasm (PAP, ×40), (b) immunohistochemistry on cell block shows p63 positivity (DAB, ×100), (c) strong CK7 positivity (DAB, ×100), (d) cervical Pap smear shows malignant squamous cells (PAP, ×200)

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Hematoxylin and eosin-stained sections from the cell block revealed small sheets of malignant squamous cells. Immunohistochemistry (IHC) for p63 and CK5/6 was strongly positive, and thyroid transcription factor-1 was negative [Figure 1]b and [Figure 1]c. Finally, on FNA cytology, diagnosis of metastatic SCC involving lymph nodes and thyroid was made. Since the primary SCC of thyroid is very rare, a search for an occult primary was done.

A whole body contrast-enhanced computed tomography was done. Multiple enlarged cervical lymph nodes and a mildly enhancing thyroid nodule in the right lobe of thyroid were detected [Figure 2]a. An ill-defined heterogeneous mass at the right hilum with bilateral pleural effusion was noted. Pelvis showed heterogeneously enhancing bulky cervix and an enhancing polypoidal mass lesion in the posterior wall of urinary bladder on the right side [Figure 2]b.
Figure 2: (a) Contrast-enhanced computed tomography neck reveals diffusely enlarged right lobe of thyroid gland with hypodense mass lesion, (b) contrast-enhanced computed tomography pelvis shows diffusely bulky and heterogeneously enhancing cervix

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Further, per speculum examination revealed an irregular hard growth in the ectocervix which was bleeding on touch. On PAP smear examination, a diagnosis of SCC was made and confirmed on cervical biopsy [Figure 1]d. Thus, the primary site for clinically occult SCC was cervix.

Despite its high vascularity, metastatic deposits to thyroid gland are uncommon.[2],[3] The common primary sites of metastatic thyroid SCC are lung, esophagus, and head and neck region.[4] Primary as cervix is rare with very few case reports present in the English literature and mostly presenting as recurrence.[1],[5]

The case illustrates that clinically occult SCC of cervix may present rarely as thyroid mass with distant lymphadenopathy. Further, cytomorphology with IHC on cell block is helpful together with clinico-radiological correlation to resolve the diagnostic challenge.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Karapanagiotou E, Saif MW, Rondoyianni D, Markaki S, Alamara C, Kiagia M, et al. Metastatic cervical carcinoma to the thyroid gland: A case report and review of the literature. Yale J Biol Med 2006;79:165-8.  Back to cited text no. 1
[PUBMED]    
2.
Khan Delia BK, Chakraborti S, Rai S, Kini H. Metastatic lesions to thyroid associated with dual primaries: A report of two cases. Thyroid Res Pract 2013;10:111-3.  Back to cited text no. 2
    
3.
Martino E, Bevilacqua G, Nardi M, Macchia E, Pinchera A. Metastatic cervical carcinoma presenting as primary thyroid cancer. Case report. Tumori 1977;63:25-30.  Back to cited text no. 3
[PUBMED]    
4.
Kundu R, Punia RS, Mohan H, Handa U, Gupta N. Fine-needle aspiration cytology of metastatic squamous cell carcinoma thyroid: A rare entity. J Cytol 2014;31:210-2.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Soriano V, Salinas I, Llatjós M, Lucas A. The recurrence of a gynecological neoplasm as a solitary thyroid nodule. Rev Clin Esp 1990;186:391-3.  Back to cited text no. 5
    

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Correspondence Address:
Prajwala Gupta
Department of Pathology, Room No. 302, O.P.D. Building, Post Graduate Institute of Medical Education and Research, Dr. RML Hospital, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_543_16

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