A Case of Squamous Cell Carcinoma of Cervical Esophagus with Metastasis to Thyroid Gland

Ju Yong Kang; Jung Jun Kim; Ik Joon Choi

doi:10.11106/ijt.2019.12.1.64

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Kang, Kim, and Choi: A Case of Squamous Cell Carcinoma of Cervical Esophagus with Metastasis to Thyroid Gland

Case Report

International Journal of Thyroidology 2019; 12(1): 64-69.

Published online: 31 May 2019

DOI: https://doi.org/10.11106/ijt.2019.12.1.64

A Case of Squamous Cell Carcinoma of Cervical Esophagus with Metastasis to Thyroid Gland

Ju Yong Kang, Jung Jun Kim, Ik Joon Choi

Department of Otorhinolaryngology-Head & Neck Surgery, Korea Cancer Center Hospital, KIRAMS, Seoul, Korea.

Correspondence: Ik Joon Choi, MD, PhD, Department of Otorhinolaryngology-Head & Neck Surgery, Korea Cancer Center Hospital, KIRAMS, 75 Nowon-ro, Nowon-gu, Seoul 01812, Korea. Tel: 82-2-970-1271, Fax: 82-2-970-2450, ijchoiorl@gmail.com

Received 31 January 2019 Revised 17 April 2019 Accepted 26 April 2019

The Korean Thyroid Association

(open-access):

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Despite thyroid is a highly vascularized organ, clinically significant metastatic spread to the thyroid is considered uncommon. There is a reported incidence of up to 24.0% metastases to the thyroid in autopsy series. The most frequently noted primary sites are the kidney, breast, and lung. The metastatic spread of alimentary tract is quite rare, and the majority comes from the colo-rectum. We present a case of squamous cell carcinoma of the cervical esophagus presenting as thyroid nodule in an apparently healthy 54 year-old male patient. This might be the first case of esophageal carcinoma metastases to the thyroid presenting in South Korea.

Keywords: Esophageal carcinoma, Squamous cell carcinoma, Thyroid metastasis

Figures and Tables

Fig. 1

Thyroid US shows 1.3×1.1×2.2 cm sized thyroid nodule with hypoechoic irregular margin in right thyroid gland (A). At the same time, 1.2×1.0×1.3 cm sized hypoechoic irregular margin nodule in left thyroid gland (B). Sono-guided FNAB was performed in these nodules.

Fig. 2

Fine needle aspiration cytology smear (A) from right thyroid nodule and (B) from level IV lymph node. High power view demonstrates sheets of atypical polygonal cells with prominent nucleoli in necrotic background. Some cells have tadpole appearance with keratinization (Papanicolaou stain, ×400).

Fig. 3

Axial (A) and coronal (B) images from a contrast-enhanced computed tomography of the thyroid show multiple conglomerated necrotic lymphadenopathies in central neck, both lateral neck, and mediastinum with posterior aspect of thyroid gland (long arrow) and bilateral tracheoesophageal groove area involvement.

Fig. 4

PET/CT images show high focal 18F-FDG uptake in the cervical esophagus and the posterior aspect of both thyroid glands (maximum SUV=16.2), high focal uptakes in right lateral neck LNs (maximum SUV=6.9), and several focal uptakes in upper thoracic esophagus (long arrow) (two lesions; maximum SUV=4.6 and 4.4) and mid thoracic esophagus (two lesions; maximum SUV=11.4 and 3.0).

Fig. 5

Endoscopic appearance shows a round protruding polyp measuring 3.0 cm, located at the of the point 32 cm far from the upper esophageal sphincter and an ulcerofungating mass located at the of the point 22 cm far from the upper esophageal sphincter (A). And an ulcerofungating mass located at the of the point 22 cm far from the upper esophageal sphincter (B).

Fig. 6

Invasive squamous cell carcinoma in endoscopic biopsy specimen from upper esophagus. Moderately differentiated lesions show sheets of large polygonal malignant cells containing keratin formation (Hematoxylin & Eosin stain, ×100).

Fig. 7

1 month later follow up thyroid CT. Axial (A) and coronal (B) images show markedly increasing in size and number of conglomerated metastatic lymphadenopathies in both retropharyngeal space, central neck, both lateral neck (long arrow) and mediastinum with invasion of both sides of tracheoesophageal groove, both sides of thyroid gland and cricoid cartilage.

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