Abstract
Follicular carcinomas are the second most common form of thyroid cancer. There are a few cases regarding initial presentation of a patient with distant metastasis leading to the diagnosis of follicular thyroid carcinoma. Most follicular thyroid carcinomas present as asymptomatic thyroid nodules, but the first sign of the disease is occasionally lymph-node metastases or in rare cases lung or bone metastases. Thirteen percentage of patients had distant metastasis at presentation, and bone metastasis constituted the majority. Vertebrae, pelvis, ribs, and femur were common sites of bone metastasis. Thus, case of metastasis to the femur only from follicular thyroid carcinoma is very rare. We recently experienced a case of follicular thyroid carcinoma with metastasis to the femur who presented with bone pain and pathologic fracture. We present this case with a review of the literature.
References
1. Hirokawa M, Carney JA, Goellner JR, DeLellis RA, Heffess CS, Katoh R, et al. Observer variation of encapsulated follicular lesions of the thyroid gland. Am J Surg Pathol. 2002. 26(11):1508–1514.
2. Chan JK. Strict criteria should be applied in the diagnosis of encapsulated follicular variant of papillary thyroid carcinoma. Am J Clin Pathol. 2002. 117(1):16–18.
3. Pittas AG, Adler M, Fazzari M, Tickoo S, Rosai J, Larson SM, et al. Bone metastases from thyroid carcinoma: clinical characteristics and prognostic variables in one hundred forty-six patients. Thyroid. 2000. 10(3):261–268.
4. Kim TH, Jung JH, Tae K, Chung WS. A case of follicular thyroid carcinoma with metastasis to the sternum. Korean J Otolaryngol-Head Neck Surg. 2010. 53:390–393.
5. Segal K, Arad A, Lubin E, Shpitzer T, Hadar T, Feinmesser R. Follicular carcinoma of the thyroid. Head Neck. 1994. 16(6):533–538.
6. Lee KY, Lore JM Jr. The treatment of metastatic thyroid disease. Otolaryngol Clin North Am. 1990. 23(3):475–493.
7. Ruegemer JJ, Hay ID, Bergstralh EJ, Ryan JJ, Offord KP, Gorman CA. Distant metastases in differentiated thyroid carcinoma: a multivariate analysis of prognostic variables. J Clin Endocrinol Metab. 1988. 67(3):501–508.
8. Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997. 174(5):474–476.
9. Park SJ, Choi CH, Goh EK, Song GS, Cha SH, Park DJ, et al. A case of thyroid follicular carcinoma metastatic to the petrous bone. J Korean Neurosurg Soc. 1997. 26(9):1303–1311.
10. D'Avanzo A, Treseler P, Ituarte PH, Wong M, Streja L, Greenspan FS, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer. 2004. 100(6):1123–1129.
11. Lang W, Choritz H, Hundeshagen H. Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings. Am J Surg Pathol. 1986. 10(4):246–255.
12. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009. 19(11):1167–1214.
13. Schlumberger M, Challeton C, De Vathaire F, Travagli JP, Gardet P, Lumbroso JD, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med. 1996. 37(4):598–605.
14. Orita Y, Sugitani I, Matsuura M, Ushijima M, Tsukahara K, Fujimoto Y, et al. Prognostic factors and the therapeutic strategy for patients with bone metastasis from differentiated thyroid carcinoma. Surgery. 2010. 147(3):424–431.
15. Garcia-Sanchis L, Lopez-Aznar D, Oltra A, Rivas A, Alonso J, Montalar J, et al. Metastatic follicular thyroid carcinoma to the kidney: a case report. Clin Nucl Med. 1999. 24(1):48–50.
16. Petrich T, Widjaja A, Musholt TJ, Hofmann M, Brunkhorst T, Ehrenheim C, et al. Outcome after radioiodine therapy in 107 patients with differentiated thyroid carcinoma and initial bone metastases: side-effects and influence of age. Eur J Nucl Med. 2001. 28(2):203–208.
17. Muresan MM, Olivier P, Leclere J, Sirveaux F, Brunaud L, Klein M, et al. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer. 2008. 15(1):37–49.
18. Niederle B, Roka R, Schemper M, Fritsch A, Weissel M, Ramach W. Surgical treatment of distant metastases in differentiated thyroid cancer: indication and results. Surgery. 1986. 100(6):1088–1097.
19. Maheshwari YK, Hill CS Jr, Haynie TP 3rd, Hickey RC, Samaan NA. 131I therapy in differentiated thyroid carcinoma: M. D. Anderson Hospital experience. Cancer. 1981. 47(4):664–671.