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A Rare Case of Metastasis to the Thyroid Gland from Renal Clear Cell Carcinoma 11 Years after Nephrectomy and Concurrent Primary Esophageal Carcinoma

A Rare Case of Metastasis to the Thyroid Gland from Renal Clear Cell Carcinoma 11 Years after... Hindawi Case Reports in Oncological Medicine Volume 2018, Article ID 3790106, 4 pages https://doi.org/10.1155/2018/3790106 Case Report A Rare Case of Metastasis to the Thyroid Gland from Renal Clear Cell Carcinoma 11 Years after Nephrectomy and Concurrent Primary Esophageal Carcinoma 1 2,3 4 Mohammad Saud Khan , Veena Balakrishnan Iyer, and Neha Varshney Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA Department of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA Department of Oncology, University of Toledo Medical Center, Toledo, OH 43614, USA Department of Pathology, University of Toledo Medical Center, Toledo, OH 43614, USA Correspondence should be addressed to Mohammad Saud Khan; mohammad.khan2@utoledo.edu Received 10 December 2017; Accepted 28 January 2018; Published 2 April 2018 Academic Editor: Katsuhiro Tanaka Copyright © 2018 Mohammad Saud Khan et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Renal cell carcinoma is known to cause metastasis to unusual sites, which can be both synchronous or metachronous. )yroid gland is a rare site for metastasis, but when it occurs, renal cell carcinoma is the most common primary neoplasm. We report the case of a 81-year-old female patient who had a significant medical history of right clear cell renal carcinoma with adrenal metastasis. She underwent right radical nephrectomy and adrenalectomy followed by radiofrequency ablation of left adrenal metastasis and systemic chemotherapy with sunitinib. Eleven years later, she presented with dysphagia and was found to have distal esophageal adenocarcinoma. On imaging, there was incidental detection of a left renal mass lesion and a right thyroid nodule, which on histopathology and immunohistochemistry were confirmed to be clear cell carcinoma of renal origin. and loss of appetite for past few weeks. She had a past 1. Introduction medical history of right RCC, clear cell carcinoma subtype )yroid gland is a rare site for clinically detectable metastasis with bilateral adrenal metastasis (T3b, N0, and M1) di- despite having rich blood supply [1]. Renal cell carcinoma (RCC) agnosed in May 2006. At that time, she was treated with right is the most common primary neoplasm that metastasizes to radical nephrectomy and right adrenalectomy followed by thyroid gland and accounts for more than 50% of clinically radiofrequency ablation of left adrenal metastasis and sys- recognized cases [2]. Other neoplasm frequently identified with temic chemotherapy with sunitinib. She tolerated the metastasis to thyroid gland includes breast, lung, skin, and colon treatment well with adequate control of her malignant cancers. Metastasis accounts for 2-3% of all thyroid malignancies disease for 11 years. Recently, in June 2017, she presented detected clinically [3, 4]. However, the incidence of thyroid with the complaints of dysphagia predominantly for solid metastasis has been reported to be higher (ranging from 1.9 to food, loss of appetite, and generalized fatigability. Physical 22.4%) on autopsy studies [5]. We report the case of a 81-year- examination was unremarkable. Esophagogastroduodeno- old female patient who developed recurrence of RCC with scopy with endoscopic ultrasound showed a distal esophagus thyroid metastasis after 11 years following nephrectomy of mass causing high-grade stricture extending up to the ad- initial tumor. ventitia with no mediastinal lymphadenopathy. Metallic esophageal stent was placed in, and biopsies were obtained which showed adenocarcinoma of esophagus (T3N0M0). 2. Case Report Computed tomography (CT) of the chest and abdomen A eighty-one-year-old African American female patient showed distal esophageal thickening along with incidental presented to the hospital with the complaints of dysphagia findings of solid mass lesion involving the inferior pole of the 2 Case Reports in Oncological Medicine (a) (b) Figure 1: (a) Axial CTscan of the abdomen showing a mass lesion involving the inferior pole of the left kidney (arrow), breaching the renal capsule and infiltrating into adjacent retroperitoneal space. (b) Axial CT scan of the chest at the level of thyroid showing a well-defined hypodense nodule in the right lobe of the thyroid gland (arrow). (a) (b) Figure 2: (a) Clear cells with increased vasculature consistent clear cell carcinoma of the kidney (40x, H&E). (b) Clear cell carcinoma invading renal vein (10x, H&E). (a) (b) Figure 3: (a) Cell block (4x, H&E) of the thyroid showing atypical cells, which are PAX-8 positive (b) consistent with metastasis of renal origin. left kidney measuring 3.4 ×2.6cm in the largest dimension carcinoma (Figure 2). Fine-needle aspiration (FNA) from (Figure 1(a)) and a well-defined hypodense nodule in the the thyroid nodule also identified neoplastic clear cells on right lobe of the thyroid gland measuring 2.1 ×2.8cm in the cytology raising possibility of metastasis from RCC (Figure largest dimension (Figure 1(b)). Biopsy of renal mass was 3(a)). )is was confirmed with immunohistochemical stain, done which showed neoplastic cells with clear cytoplasm which showed atypical cells to be positive for PAX8 (Figure arranged in nests and mitotic figures suggesting clear cell 3(b)) and CAIX while negative for TTF-1. Positron emission Case Reports in Oncological Medicine 3 However, sometimes it is difficult to distinguish metastasis tomography (PET) scans showed increased uptake in the distal esophagus, left renal mass, and right thyroid nodule. A di- from tumors of thyroid, which can have clear cell compo- nent on FNA cytology alone. In these cases, immunohis- agnosis of concurrent distal esophageal adenocarcinoma along with left renal RCC recurrence and thyroid metastasis was tochemistry is helpful and aids in differential diagnosis. made. )e patient was planned for left nephrectomy and Some of the traditional immunohistochemical markers for thyroidectomy. However, the patient wished to opt out for any renal cell carcinoma are cytokeratin, vimentin, and CD10 surgical intervention or aggressive medical therapy and pre- [14]. However, recently novel markers for RCC have been ferred to be treated with comfort care measures. )e patient identified which have increased sensitivity and specificity for was treated with palliative intention and died 2 months later. identifying RCC. )ese include anti-carbonic anhydrase IX (CAIX), anti-human kidney injury molecule-1 (hKIM-1), and PAX8 [15]. )e immunohistochemical markers used for 3. Discussion identifying primary thyroid malignancies are thyroglobulin, RCC accounts for approximately 3-4% of all adult malig- thyroid transcription factor-1 (TTF-1), and calcitonin. In our case, immunohistochemical stains were positive for nancies [6]. It is the most common renal malignancy and the second most common malignancy of urological tract [6, 7]. CAIX and PAX-8 and negative for TTF-1. RCC is more common in males compared to females (ratio of Definitive diagnosis of metastatic RCC is usually made 2:1) and occurs predominantly in the 6th to 8th decade of life by histopathological examination after thyroidectomy. with a median age of 64 years [6]. Major histopathological Surgical resection with either partial or total thyroidectomy subtypes include clear cell carcinoma, papillary carcinoma, should be performed if thyroid gland is the only site for chromophobe carcinoma, collecting duct carcinoma, med- metastasis. Prognosis is good in this group [3, 16]. Patients ullary carcinoma, and unclassified categories [8]. Clear cell with disseminated disease have poor prognosis and should carcinoma is the most common subtype making up to 75% of undergo thyroidectomy only for palliation for compressive symptoms [16]. cases of RCC [9]. RCC is known to metastasize in un- predictable manner. )e metastasis may be detected at the time of diagnosis (synchronous) or may be found years after 4. Conclusion the diagnosis and treatment (metachronous) [7]. )e most common route of metastasis is hematogenous and likely A thyroid nodule in a patient with a history of renal ma- lignancy should be considered as potentially metastatic. involves lung, liver, bone, lymph nodes, adrenal gland, and Clinical manifestation and radiographic findings are non- brain. Head and neck metastasis are less frequent and of specific and are unable to distinguish between primary and which thyroid is the most commonly involved site. Late re- secondary thyroid neoplasms. FNA cytology and immu- currences and distant metastasis ranging from few months to nohistochemistry are helpful in establishing diagnosis and several years after initial diagnosis are a notable feature of should be obtained in suspected cases. RCC. It has been estimated that 20–30% of patients including those who have undergone nephrectomy with curative intent will develop recurrence and out of these 50% will relapse Conflicts of Interest distantly [7, 10]. Most of the recurrences are within 3 years of )e authors declare that no conflicts of interest exist re- surgery, but delayed recurrences even after decades have been garding the publication of this paper. reported [11]. )e longer the recurrence-free time from surgery, the more likelihood is of a true cure. In majority of cases, thyroid metastasis is metachronous References with average time of development being 9.4 years following [1] M. K. Nakhjavani, H. Gharib, J. R. Goellner, and J. A. van resection of primary RCC [12]. But cases of RCC recurring Heerden, “Metastasis to the thyroid gland. A report of 43 with thyroid metastasis have been reported as late as 26 years cases,” Cancer, vol. 79, no. 3, pp. 574–578, 1997. [1]. )ese metastatic thyroid lesions may pose diagnostic [2] H. Chen, T. L. Nicol, and R. Udelsman, “Clinically significant, challenge since they often occur years after treatment of isolated metastatic disease to the thyroid gland,” World primary lesion. RCC metastasis to thyroid can be asymp- Journal of Surgery, vol. 23, no. 2, pp. 177–180, 1999. tomatic and may be detected incidentally or may present [3] A. Y. Chung, T. B. Tran, K. T. Brumund, R. A. Weisman, and with symptoms of palpable neck swelling, thyroid en- M. Bouvet, “Metastases to the thyroid: a review of the literature largement, dysphagia, dysphonia, or dyspnea [3]. Although from the last decade,” (yroid, vol. 22, no. 3, pp. 258–268, 2012. [4] L. Hegerova, M. L. Griebeler, J. P. Reynolds, M. R. Henry, and metastasis to the thyroid gland may be suspected in patients H. Gharib, “Metastasis to the thyroid gland: report of a large with history of RCC, it is difficult to make a definitive series from the Mayo Clinic,” American Journal of Clinical preoperative diagnosis. Metastatic thyroid lesions usually Oncology, vol. 38, no. 4, pp. 338–342, 2015. appear as solid, hypoechoic, well-demarcated nodules with [5] R. A. Willis, “Metastatic tumours in the thyroid gland,” irregular border and increased vascularity on ultrasound American Journal of Pathology, vol. 7, no. 3, pp.187–208, 1931. imaging [13] and cold nodules on radioisotope uptake [6] R. L. Siegel, K. D. Miller, and A. Jemal, “Cancer statistics, 2016,” studies. )ese radiological features are nonspecific, and it is CA: A Cancer Journal for Clinicians, vol. 66, no.1, pp. 7–30, 2016. not possible to distinguish between primary and secondary [7] R. J. Motzer, N. H. Bander, and D. M. Nanus, “Renal-cell thyroid neoplasms on imaging. FNA cytology serves as carcinoma,” New England Journal of Medicine, vol. 335, no.12, a reliable tool for establishing preoperative diagnosis. pp. 865–875, 1996. 4 Case Reports in Oncological Medicine [8] G. Kovacs, M. Akhtar, B. J. Beckwith et al., “)e Heidelberg classification of renal cell tumours,” Journal of Pathology, vol. 183, no. 2, pp. 131–133, 1997. [9] J. J. Hsieh, M. P. Purdue, S. Signoretti et al., “Renal cell carcinoma,” Nature Reviews Disease Primers, vol. 3, p. 17009, 2017. [10] R. C. Flanigan, S. C. Campbell, J. I. Clark, and M. M. Picken, “Metastatic renal cell carcinoma,” Current Treatment Options in Oncology, vol. 4, no. 5, pp. 385–390, 2003. [11] S. E. Eggener, O. Yossepowitch, J. A. Pettus, M. E. Snyder, R. J. Motzer, and P. Russo, “Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence,” Journal of Clinical Oncology, vol. 24, no. 19, pp. 3101–3106, 2006. [12] C. S. Heffess, B. M. Wenig, and L. D. )ompson, “Metastatic renal cell carcinoma to the thyroid gland: a clinicopathologic study of 36 cases,” Cancer, vol. 95, no. 9, pp. 1869–1878, 2002. [13] K. Kobayashi, M. Hirokawa, T. Yabuta et al., “Metastatic carcinoma to the thyroid gland from renal cell carcinoma: role of ultrasonography in preoperative diagnosis,” (yroid Re- search, vol. 8, no. 1, p. 4, 2015. [14] L. D. Truong and S. S. Shen, “Immunohistochemical diagnosis of renal neoplasms,” Archives of Pathology & Laboratory Medicine, vol. 135, no. 1, pp. 92–109, 2011. [15] A.R.Sangoi,M.Fujiwara,R.B.Westetal.,“Immunohistochemical distinctionof primaryadrenal cortical lesionsfrom metastatic clear cell renal cell carcinoma: a study of 248 cases,” American Journal of Surgical Pathology, vol. 35, no. 5, pp. 678–686, 2011. [16] R. De Stefano, R. Carluccio, E. Zanni et al., “Management of thyroid nodules as secondary involvement of renal cell carcinoma: case report and literature review,” Anticancer Research, vol. 29, no. 2, pp. 473–476, 2009. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

A Rare Case of Metastasis to the Thyroid Gland from Renal Clear Cell Carcinoma 11 Years after Nephrectomy and Concurrent Primary Esophageal Carcinoma

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Copyright © 2018 Mohammad Saud Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2018, Article ID 3790106, 4 pages https://doi.org/10.1155/2018/3790106 Case Report A Rare Case of Metastasis to the Thyroid Gland from Renal Clear Cell Carcinoma 11 Years after Nephrectomy and Concurrent Primary Esophageal Carcinoma 1 2,3 4 Mohammad Saud Khan , Veena Balakrishnan Iyer, and Neha Varshney Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA Department of Hematology and Oncology, Rhode Island Hospital, Providence, RI, USA Department of Oncology, University of Toledo Medical Center, Toledo, OH 43614, USA Department of Pathology, University of Toledo Medical Center, Toledo, OH 43614, USA Correspondence should be addressed to Mohammad Saud Khan; mohammad.khan2@utoledo.edu Received 10 December 2017; Accepted 28 January 2018; Published 2 April 2018 Academic Editor: Katsuhiro Tanaka Copyright © 2018 Mohammad Saud Khan et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Renal cell carcinoma is known to cause metastasis to unusual sites, which can be both synchronous or metachronous. )yroid gland is a rare site for metastasis, but when it occurs, renal cell carcinoma is the most common primary neoplasm. We report the case of a 81-year-old female patient who had a significant medical history of right clear cell renal carcinoma with adrenal metastasis. She underwent right radical nephrectomy and adrenalectomy followed by radiofrequency ablation of left adrenal metastasis and systemic chemotherapy with sunitinib. Eleven years later, she presented with dysphagia and was found to have distal esophageal adenocarcinoma. On imaging, there was incidental detection of a left renal mass lesion and a right thyroid nodule, which on histopathology and immunohistochemistry were confirmed to be clear cell carcinoma of renal origin. and loss of appetite for past few weeks. She had a past 1. Introduction medical history of right RCC, clear cell carcinoma subtype )yroid gland is a rare site for clinically detectable metastasis with bilateral adrenal metastasis (T3b, N0, and M1) di- despite having rich blood supply [1]. Renal cell carcinoma (RCC) agnosed in May 2006. At that time, she was treated with right is the most common primary neoplasm that metastasizes to radical nephrectomy and right adrenalectomy followed by thyroid gland and accounts for more than 50% of clinically radiofrequency ablation of left adrenal metastasis and sys- recognized cases [2]. Other neoplasm frequently identified with temic chemotherapy with sunitinib. She tolerated the metastasis to thyroid gland includes breast, lung, skin, and colon treatment well with adequate control of her malignant cancers. Metastasis accounts for 2-3% of all thyroid malignancies disease for 11 years. Recently, in June 2017, she presented detected clinically [3, 4]. However, the incidence of thyroid with the complaints of dysphagia predominantly for solid metastasis has been reported to be higher (ranging from 1.9 to food, loss of appetite, and generalized fatigability. Physical 22.4%) on autopsy studies [5]. We report the case of a 81-year- examination was unremarkable. Esophagogastroduodeno- old female patient who developed recurrence of RCC with scopy with endoscopic ultrasound showed a distal esophagus thyroid metastasis after 11 years following nephrectomy of mass causing high-grade stricture extending up to the ad- initial tumor. ventitia with no mediastinal lymphadenopathy. Metallic esophageal stent was placed in, and biopsies were obtained which showed adenocarcinoma of esophagus (T3N0M0). 2. Case Report Computed tomography (CT) of the chest and abdomen A eighty-one-year-old African American female patient showed distal esophageal thickening along with incidental presented to the hospital with the complaints of dysphagia findings of solid mass lesion involving the inferior pole of the 2 Case Reports in Oncological Medicine (a) (b) Figure 1: (a) Axial CTscan of the abdomen showing a mass lesion involving the inferior pole of the left kidney (arrow), breaching the renal capsule and infiltrating into adjacent retroperitoneal space. (b) Axial CT scan of the chest at the level of thyroid showing a well-defined hypodense nodule in the right lobe of the thyroid gland (arrow). (a) (b) Figure 2: (a) Clear cells with increased vasculature consistent clear cell carcinoma of the kidney (40x, H&E). (b) Clear cell carcinoma invading renal vein (10x, H&E). (a) (b) Figure 3: (a) Cell block (4x, H&E) of the thyroid showing atypical cells, which are PAX-8 positive (b) consistent with metastasis of renal origin. left kidney measuring 3.4 ×2.6cm in the largest dimension carcinoma (Figure 2). Fine-needle aspiration (FNA) from (Figure 1(a)) and a well-defined hypodense nodule in the the thyroid nodule also identified neoplastic clear cells on right lobe of the thyroid gland measuring 2.1 ×2.8cm in the cytology raising possibility of metastasis from RCC (Figure largest dimension (Figure 1(b)). Biopsy of renal mass was 3(a)). )is was confirmed with immunohistochemical stain, done which showed neoplastic cells with clear cytoplasm which showed atypical cells to be positive for PAX8 (Figure arranged in nests and mitotic figures suggesting clear cell 3(b)) and CAIX while negative for TTF-1. Positron emission Case Reports in Oncological Medicine 3 However, sometimes it is difficult to distinguish metastasis tomography (PET) scans showed increased uptake in the distal esophagus, left renal mass, and right thyroid nodule. A di- from tumors of thyroid, which can have clear cell compo- nent on FNA cytology alone. In these cases, immunohis- agnosis of concurrent distal esophageal adenocarcinoma along with left renal RCC recurrence and thyroid metastasis was tochemistry is helpful and aids in differential diagnosis. made. )e patient was planned for left nephrectomy and Some of the traditional immunohistochemical markers for thyroidectomy. However, the patient wished to opt out for any renal cell carcinoma are cytokeratin, vimentin, and CD10 surgical intervention or aggressive medical therapy and pre- [14]. However, recently novel markers for RCC have been ferred to be treated with comfort care measures. )e patient identified which have increased sensitivity and specificity for was treated with palliative intention and died 2 months later. identifying RCC. )ese include anti-carbonic anhydrase IX (CAIX), anti-human kidney injury molecule-1 (hKIM-1), and PAX8 [15]. )e immunohistochemical markers used for 3. Discussion identifying primary thyroid malignancies are thyroglobulin, RCC accounts for approximately 3-4% of all adult malig- thyroid transcription factor-1 (TTF-1), and calcitonin. In our case, immunohistochemical stains were positive for nancies [6]. It is the most common renal malignancy and the second most common malignancy of urological tract [6, 7]. CAIX and PAX-8 and negative for TTF-1. RCC is more common in males compared to females (ratio of Definitive diagnosis of metastatic RCC is usually made 2:1) and occurs predominantly in the 6th to 8th decade of life by histopathological examination after thyroidectomy. with a median age of 64 years [6]. Major histopathological Surgical resection with either partial or total thyroidectomy subtypes include clear cell carcinoma, papillary carcinoma, should be performed if thyroid gland is the only site for chromophobe carcinoma, collecting duct carcinoma, med- metastasis. Prognosis is good in this group [3, 16]. Patients ullary carcinoma, and unclassified categories [8]. Clear cell with disseminated disease have poor prognosis and should carcinoma is the most common subtype making up to 75% of undergo thyroidectomy only for palliation for compressive symptoms [16]. cases of RCC [9]. RCC is known to metastasize in un- predictable manner. )e metastasis may be detected at the time of diagnosis (synchronous) or may be found years after 4. Conclusion the diagnosis and treatment (metachronous) [7]. )e most common route of metastasis is hematogenous and likely A thyroid nodule in a patient with a history of renal ma- lignancy should be considered as potentially metastatic. involves lung, liver, bone, lymph nodes, adrenal gland, and Clinical manifestation and radiographic findings are non- brain. Head and neck metastasis are less frequent and of specific and are unable to distinguish between primary and which thyroid is the most commonly involved site. Late re- secondary thyroid neoplasms. FNA cytology and immu- currences and distant metastasis ranging from few months to nohistochemistry are helpful in establishing diagnosis and several years after initial diagnosis are a notable feature of should be obtained in suspected cases. RCC. It has been estimated that 20–30% of patients including those who have undergone nephrectomy with curative intent will develop recurrence and out of these 50% will relapse Conflicts of Interest distantly [7, 10]. Most of the recurrences are within 3 years of )e authors declare that no conflicts of interest exist re- surgery, but delayed recurrences even after decades have been garding the publication of this paper. reported [11]. )e longer the recurrence-free time from surgery, the more likelihood is of a true cure. In majority of cases, thyroid metastasis is metachronous References with average time of development being 9.4 years following [1] M. K. Nakhjavani, H. Gharib, J. R. Goellner, and J. A. van resection of primary RCC [12]. But cases of RCC recurring Heerden, “Metastasis to the thyroid gland. A report of 43 with thyroid metastasis have been reported as late as 26 years cases,” Cancer, vol. 79, no. 3, pp. 574–578, 1997. [1]. )ese metastatic thyroid lesions may pose diagnostic [2] H. Chen, T. L. Nicol, and R. Udelsman, “Clinically significant, challenge since they often occur years after treatment of isolated metastatic disease to the thyroid gland,” World primary lesion. RCC metastasis to thyroid can be asymp- Journal of Surgery, vol. 23, no. 2, pp. 177–180, 1999. tomatic and may be detected incidentally or may present [3] A. Y. Chung, T. B. Tran, K. T. Brumund, R. A. Weisman, and with symptoms of palpable neck swelling, thyroid en- M. Bouvet, “Metastases to the thyroid: a review of the literature largement, dysphagia, dysphonia, or dyspnea [3]. Although from the last decade,” (yroid, vol. 22, no. 3, pp. 258–268, 2012. [4] L. Hegerova, M. L. Griebeler, J. P. Reynolds, M. R. Henry, and metastasis to the thyroid gland may be suspected in patients H. Gharib, “Metastasis to the thyroid gland: report of a large with history of RCC, it is difficult to make a definitive series from the Mayo Clinic,” American Journal of Clinical preoperative diagnosis. Metastatic thyroid lesions usually Oncology, vol. 38, no. 4, pp. 338–342, 2015. appear as solid, hypoechoic, well-demarcated nodules with [5] R. A. Willis, “Metastatic tumours in the thyroid gland,” irregular border and increased vascularity on ultrasound American Journal of Pathology, vol. 7, no. 3, pp.187–208, 1931. imaging [13] and cold nodules on radioisotope uptake [6] R. L. Siegel, K. D. Miller, and A. Jemal, “Cancer statistics, 2016,” studies. )ese radiological features are nonspecific, and it is CA: A Cancer Journal for Clinicians, vol. 66, no.1, pp. 7–30, 2016. not possible to distinguish between primary and secondary [7] R. J. Motzer, N. H. Bander, and D. M. Nanus, “Renal-cell thyroid neoplasms on imaging. FNA cytology serves as carcinoma,” New England Journal of Medicine, vol. 335, no.12, a reliable tool for establishing preoperative diagnosis. pp. 865–875, 1996. 4 Case Reports in Oncological Medicine [8] G. Kovacs, M. Akhtar, B. J. Beckwith et al., “)e Heidelberg classification of renal cell tumours,” Journal of Pathology, vol. 183, no. 2, pp. 131–133, 1997. [9] J. J. Hsieh, M. P. Purdue, S. Signoretti et al., “Renal cell carcinoma,” Nature Reviews Disease Primers, vol. 3, p. 17009, 2017. [10] R. C. Flanigan, S. C. Campbell, J. I. Clark, and M. M. Picken, “Metastatic renal cell carcinoma,” Current Treatment Options in Oncology, vol. 4, no. 5, pp. 385–390, 2003. [11] S. E. Eggener, O. Yossepowitch, J. A. Pettus, M. E. Snyder, R. J. Motzer, and P. Russo, “Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence,” Journal of Clinical Oncology, vol. 24, no. 19, pp. 3101–3106, 2006. [12] C. S. Heffess, B. M. Wenig, and L. D. )ompson, “Metastatic renal cell carcinoma to the thyroid gland: a clinicopathologic study of 36 cases,” Cancer, vol. 95, no. 9, pp. 1869–1878, 2002. [13] K. Kobayashi, M. Hirokawa, T. Yabuta et al., “Metastatic carcinoma to the thyroid gland from renal cell carcinoma: role of ultrasonography in preoperative diagnosis,” (yroid Re- search, vol. 8, no. 1, p. 4, 2015. [14] L. D. Truong and S. S. Shen, “Immunohistochemical diagnosis of renal neoplasms,” Archives of Pathology & Laboratory Medicine, vol. 135, no. 1, pp. 92–109, 2011. [15] A.R.Sangoi,M.Fujiwara,R.B.Westetal.,“Immunohistochemical distinctionof primaryadrenal cortical lesionsfrom metastatic clear cell renal cell carcinoma: a study of 248 cases,” American Journal of Surgical Pathology, vol. 35, no. 5, pp. 678–686, 2011. [16] R. De Stefano, R. Carluccio, E. Zanni et al., “Management of thyroid nodules as secondary involvement of renal cell carcinoma: case report and literature review,” Anticancer Research, vol. 29, no. 2, pp. 473–476, 2009. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

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Published: Apr 2, 2018

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