Metastatic thyroid carcinoma without identifiable primary tumor within the thyroid gland

a retrospective study of a rare phenomenon

Bin Xu, Theresa Scognamiglio, Perry R. Cohen, Manju L. Prasad, Adnan Hasanovic, Robert Michael Tuttle, Nora Katabi, Ronald A. Ghossein

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Metastatic papillary thyroid carcinoma (PTC) without an identifiable primary tumor despite extensive microscopic examination of the thyroid gland is a rare but true phenomenon.We retrieved 7 of such cases and described in detail the clinical and pathologic features of these tumors. BRAF V600E immunohistochemistry and Sequenom molecular profile were conducted in selected cases. All patients harbored metastatic disease in the central (n = 3), lateral (n = 3), or both neck compartments (n = 1). The histotype of the metastatic disease was PTC (n = 5), poorly differentiated thyroid carcinoma in association with a PTC columnar variant (n = 1), and anaplastic thyroid carcinoma in association with a PTC tall cell variant (n = 1). Fibrosis was present in the thyroid of 5 patients. All patients with PTC were alive without evidence of recurrence. The 76-year-old patient with poorly differentiated thyroid carcinoma did not recur and died of unknown causes. Finally, the patient with anaplastic thyroid carcinoma was alive with distant metastasis at last follow-up. The median follow-up for this cohort was 2.2 years (range, 0.8-17). BRAF V600E was detected in 4 of 6 cases by immunohistochemistry. In conclusion, metastatic nodal disease without identifiable thyroid primary is a rare but real phenomenon of unknown mechanisms. Although most tumors are low grade and well differentiated, aggressive behavior due to poorly differentiated or anaplastic carcinoma can happen. Most cases are BRAFV600E-positive thyroid tumors. A papillary carcinoma phenotype is found in all reported cases.

Original languageEnglish (US)
Pages (from-to)133-139
Number of pages7
JournalHuman Pathology
Volume65
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Fingerprint

Thyroid Neoplasms
Thyroid Gland
Retrospective Studies
Neoplasms
Immunohistochemistry
Papillary Carcinoma
Fibrosis
Neck
Papillary Thyroid cancer
Neoplasm Metastasis
Carcinoma
Phenotype
Recurrence
Anaplastic Thyroid Carcinoma

Keywords

  • Anaplastic thyroid carcinoma
  • BRAF
  • Lymph node metastasis
  • Occult primary thyroid carcinoma
  • Papillary thyroid carcinoma
  • Poorly differentiated thyroid carcinoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Metastatic thyroid carcinoma without identifiable primary tumor within the thyroid gland : a retrospective study of a rare phenomenon. / Xu, Bin; Scognamiglio, Theresa; Cohen, Perry R.; Prasad, Manju L.; Hasanovic, Adnan; Tuttle, Robert Michael; Katabi, Nora; Ghossein, Ronald A.

In: Human Pathology, Vol. 65, 01.07.2017, p. 133-139.

Research output: Contribution to journalArticle

Xu, Bin ; Scognamiglio, Theresa ; Cohen, Perry R. ; Prasad, Manju L. ; Hasanovic, Adnan ; Tuttle, Robert Michael ; Katabi, Nora ; Ghossein, Ronald A. / Metastatic thyroid carcinoma without identifiable primary tumor within the thyroid gland : a retrospective study of a rare phenomenon. In: Human Pathology. 2017 ; Vol. 65. pp. 133-139.
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