Metastases to the thyroid gland from renal carcinoma are observed in 10% of the uncommon metastatic thyroid tumours. They are the first sign of renal carcinoma in 25% of cases or appear after primary treatment of renal neoplasia, up to 27 years later. Metastases are more frequent in pathological glands, perhaps because intraparenchimal blood flow is slowed and tissue oxygen partial pressure is reduced. Thyroid metastases are frequently associated with lung ones, whether those associated with metastases to other organs (duodenum, pancreas, skin) are very unusual. Clinical manifestations are thyroid node without hormonal modifications or acute swelling of the gland with hormonal hyperfunction; other signs are dysphonia and/or dysphagia. Thyroid nodes are 'cold' at 131I scanning and with mixed structure at ultrasonography. Fine needle aspiration is often diagnostic. Problems in differential diagnosis are among clear-cell renal carcinoma and some types of thyroid adenoma, surrenalic carcinoma, parathyroid carcinoma, testicular seminoma and hypernephroid thyroid carcinoma. Treatment is surgical: subtotal or total lobectomy, with or without istmectomy, if metastasis is single, total thyroidectomy in diffuse disease. Some Authors always choice total thyroidectomy to erase microscopic foci of disease in controlateral lobe. Reported survival after treatment is from a few months to 27 years. Survival is longer with a metastasis appearing after nephrectomy and with unique versus multiple ones. Case report. L.A., woman, aged 65 years, observed on Jan 12th, 1992. In Dec 1979 she underwent a left nephroureterectomy for clear cell renal carcinoma. In Dec 1980 right lung metastases were observed. She received MAP 500 mg/daily for 15 days and telecobaltotherapy with X-rays proved remission of metastases. In Feb 1987, in the left paraumbelical region of abdominal wall, a lump was observed, which grew to 4 cm of diameter. In Sep 1991 a 3-cm nodule was detected in left lobe of thyroid gland. At ultrasonography a 1-cm node was detected in the right lobe (it was isoechogenic with peripheral hypoechogenic halo); two nodes (with diameter of 13 and 37 mm) were detected in the left lobe. Hormones were normal. A 'cold' node was observed at scanning. Fine needle aspiration was inconclusive. The patient underwent, on Jan 24, 1992, an excision of the paraumbelical lump and a total thyroidectomy. Histology was colloid-cystic struma with clear-cell renal carcinoma metastasis to the thyroid and metastasis to abdominal wall. After eight months, the patient is in complete remission on immuno-chemiotherapy. Authors stress that treatment of this unusual clinical condition should be indicated only if metastatic disease appears after the diagnosis of the renal carcinoma (if metastases appear before diagnosis of renal disease, survival is too short). Surgical excision is the treatment of choice, also to relieve compression of airways.
Thyroid and skin metastases from renal carcinoma
Nicolosi A.;Calo' P. G.;
1994-01-01
Abstract
Metastases to the thyroid gland from renal carcinoma are observed in 10% of the uncommon metastatic thyroid tumours. They are the first sign of renal carcinoma in 25% of cases or appear after primary treatment of renal neoplasia, up to 27 years later. Metastases are more frequent in pathological glands, perhaps because intraparenchimal blood flow is slowed and tissue oxygen partial pressure is reduced. Thyroid metastases are frequently associated with lung ones, whether those associated with metastases to other organs (duodenum, pancreas, skin) are very unusual. Clinical manifestations are thyroid node without hormonal modifications or acute swelling of the gland with hormonal hyperfunction; other signs are dysphonia and/or dysphagia. Thyroid nodes are 'cold' at 131I scanning and with mixed structure at ultrasonography. Fine needle aspiration is often diagnostic. Problems in differential diagnosis are among clear-cell renal carcinoma and some types of thyroid adenoma, surrenalic carcinoma, parathyroid carcinoma, testicular seminoma and hypernephroid thyroid carcinoma. Treatment is surgical: subtotal or total lobectomy, with or without istmectomy, if metastasis is single, total thyroidectomy in diffuse disease. Some Authors always choice total thyroidectomy to erase microscopic foci of disease in controlateral lobe. Reported survival after treatment is from a few months to 27 years. Survival is longer with a metastasis appearing after nephrectomy and with unique versus multiple ones. Case report. L.A., woman, aged 65 years, observed on Jan 12th, 1992. In Dec 1979 she underwent a left nephroureterectomy for clear cell renal carcinoma. In Dec 1980 right lung metastases were observed. She received MAP 500 mg/daily for 15 days and telecobaltotherapy with X-rays proved remission of metastases. In Feb 1987, in the left paraumbelical region of abdominal wall, a lump was observed, which grew to 4 cm of diameter. In Sep 1991 a 3-cm nodule was detected in left lobe of thyroid gland. At ultrasonography a 1-cm node was detected in the right lobe (it was isoechogenic with peripheral hypoechogenic halo); two nodes (with diameter of 13 and 37 mm) were detected in the left lobe. Hormones were normal. A 'cold' node was observed at scanning. Fine needle aspiration was inconclusive. The patient underwent, on Jan 24, 1992, an excision of the paraumbelical lump and a total thyroidectomy. Histology was colloid-cystic struma with clear-cell renal carcinoma metastasis to the thyroid and metastasis to abdominal wall. After eight months, the patient is in complete remission on immuno-chemiotherapy. Authors stress that treatment of this unusual clinical condition should be indicated only if metastatic disease appears after the diagnosis of the renal carcinoma (if metastases appear before diagnosis of renal disease, survival is too short). Surgical excision is the treatment of choice, also to relieve compression of airways.
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