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 Table of Contents     
CASE REPORT
Year : 2016  |  Volume : 31  |  Issue : 3  |  Page : 232-234  

Renal metastasis from papillary carcinoma thyroid detected by whole body iodine scan: A case report and review of the literature


1 Department of Nuclear Medicine, Regional Cancer Centre, Trivandrum, Kerala, India
2 Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India

Date of Web Publication7-Jun-2016

Correspondence Address:
Lekha M Nair
Sreeparvathy, Ulloor Gardens, UG-98, Medical College, P.O, Trivandrum, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.183618

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   Abstract 


Papillary carcinoma is the most common thyroid malignancy. Usual sites of metastasis include lungs and bone, but renal metastasis is very rare. Here we present a case of a follicular variant of papillary carcinoma with renal and lung metastasis at presentation.

Keywords: Papillary carcinoma, radioiodine, renal metastasis


How to cite this article:
Nair LM, Anila K R, Sreekumar A, Pradeep V M. Renal metastasis from papillary carcinoma thyroid detected by whole body iodine scan: A case report and review of the literature. Indian J Nucl Med 2016;31:232-4

How to cite this URL:
Nair LM, Anila K R, Sreekumar A, Pradeep V M. Renal metastasis from papillary carcinoma thyroid detected by whole body iodine scan: A case report and review of the literature. Indian J Nucl Med [serial online] 2016 [cited 2019 Dec 9];31:232-4. Available from: http://www.ijnm.in/text.asp?2016/31/3/232/183618




   Introduction Top


Papillary carcinoma is the most common thyroid malignancy and is usually associated with good outcome. However, some variants of papillary carcinoma behave aggressively and have a poor prognosis. The aggressive histological variants include diffuse sclerosing variant, tall cell, columnar cell, and cobnail variants. Usual sites of metastasis include lungs and bone and rarely to the kidney. Here we present a case of follicular variant (FV) of papillary carcinoma with renal and lung metastasis at presentation.


   Case Report Top


A 37-year-old male presented to us after total thyroidectomy and right modified radical neck dissection with the histopathological diagnosis of FV of papillary carcinoma thyroid. Postoperative serum thyroglobulin was above 1000 ng/ml. A whole body iodine scan showed intense iodine uptake in lungs and right side of abdomen [Figure 1], which on ultrasound abdomen was found to be right renal mass. Computed tomography (CT) scan showed an enhancing lobulated mass lesion 8.5 cm × 8.5 cm × 7.7 cm arising from the lower pole of right kidney [Figure 2]. Ultrasound-guided fine needle aspiration (FNA) cytology from the renal mass showed adenocarcinoma, morphologically compatible with metastasis from thyroid primary [Figure 3]a and [Figure 3]b. Immunocytochemical staining showed the tumor cells to be positive for thyroglobulin [Figure 3]c. Hence, a cytopathological diagnosis of metastatic papillary carcinoma of the kidney was made. In view of extensive lung metastases, nephrectomy was not planned, and the patient was treated with 100 mCi radio-iodine. Currently, he is asymptomatic; serum thyroglobulin is above 500 ng/ml. We are planning to go for further high dose radioiodine treatment.
Figure 1: Postoperative whole body iodine scan showing uptake in lungs and right side of abdomen in anterior and posterior views

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Figure 2: Contrast enhanced computed tomography scan of abdomen showing enhancing lobulated mass arising from right kidney

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Figure 3: (a) Cellular smear showing sheets and papillaroid clusters of atypical cells (PAP*200). (b) Higher power view shows atypical cells with vesicular nucleus,intranuclear grooves and occasional intranuclear inclusions (PAP *400). (c) Atypical cells showing focal moderate positivity for thyroglobulin (IHC, ×400)

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   Discussion Top


Thyroid malignancies usually metastasize to bone and lungs, and renal metastasis is relatively uncommon. Thyroid carcinoma accounts for only 2.5–2.7% of all primary tumors that metastasize to the kidney. Renal metastases are found at autopsy than during life.[1],[2] Renal metastasis usually occurs along with other sites of metastasis such as lung or bone. Metastasis to the kidney can develop several years after thyroidectomy [3],[4] or it can present primarily as a renal mass.[5],[6] To the best of our knowledge, only thirty cases of renal metastasis from thyroid carcinoma have been reported. Seven cases of renal metastases from FV of papillary carcinoma are already reported [Table 1]. This is the 8th case of FV of papillary thyroid carcinoma with asymptomatic renal metastasis at presentation.
Table 1: Renal metastasis from follicular variant of papillary carcinoma-reported cases

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In our patient, the renal lesion was detected in the postoperative whole body iodine scan and was confirmed with CT scan and cytopathology. In case of low volume metastatic disease, surgical excision of the lesion followed by radioiodine treatment gives best results. Surgery was not attempted in our patient because of extensive lung metastases.

Renal metastasis from thyroid cancer is usually a diagnostic challenge because of its rarity. Diagnosis is difficult on cytology specimens. Usually histopathological examination along with immunohistochemical studies with markers such as thyroglobulin, thyroid transcription factor-1, PAX-8 are needed for diagnosis. In our patient, we could diagnose metastasis in cytology from the FNA sample, the origin from thyroid was confirmed by thyroglobulin positivity in the malignant cells by immunocytochemistry. Metastatic lesion may retain adequate sodium-iodide symporter expression so that they can be detected on whole body iodine scan/single-photon emission computed tomography/CT.[10] In such situations, they can be effectively treated with radioiodine as in our case.


   Conclusion Top


We report this case because of its rarity and also due to the challenge we faced in cytology and immunocytochemistry in diagnosing this in FNA specimen without subjecting the patient to biopsy. However, any abnormal uptake in abdomen other than the physiological gastrointestinal uptake also requires radiological correlation.[13]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Bracken RB, Chica G, Johnson DE, Luna M. Secondary renal neoplasms: An autopsy study. South Med J 1979;72:806-7.  Back to cited text no. 1
[PUBMED]    
2.
Heitz P, Moser H, Staub JJ. Thyroid cancer: A study of 573 thyroid tumors and 161 autopsy cases observed over a thirty-year period. Cancer 1976;37:2329-37.  Back to cited text no. 2
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3.
Moudouni SM, En-Nia I, Rioux-Leclerq N, Manunta A, Guille F, Lobel B. Follicular carcinoma of the thyroid metastasis to the kidney nine years after resection of the primary tumor. Ann Urol (Paris) 2002;36:36-7.  Back to cited text no. 3
    
4.
Johnson MW, Morettin LB, Sarles HE, Zaharopoulos P. Follicular carcinoma of the thyroid metastatic to the kidney 37 years after resection of the primary tumor. J Urol 1982;127:114-6.  Back to cited text no. 4
[PUBMED]    
5.
Ruggiero FP, Frauenhoffer EE, Stack BC Jr. Papillary thyroid cancer with an initial presentation of abdominal and flank pain. Am J Otolaryngol 2005;26:142-5.  Back to cited text no. 5
    
6.
Xu H, Zeng W, Tang Y. Metastatic thyroid follicular carcinoma presenting as a primary renal tumor. Intern Med 2012;51:2193-6.  Back to cited text no. 6
    
7.
Tur GE, Asanuma Y, Sato T, Kotanagi H, Sageshima M, Yong-Jie Z, et al. Resection of metastatic thyroid carcinomas to the liver and the kidney: Report of a case. Surg Today 1994;24:844-8.  Back to cited text no. 7
    
8.
Graham LD, Roe SM. Metastatic papillary thyroid carcinoma presenting as a primary renal neoplasm. Am Surg 1995;61:732-4.  Back to cited text no. 8
    
9.
Gamboa-Dominguez A, Tenorio-Villalvazo A. Metastatic follicular variant of papillary thyroid carcinoma manifested as a primary renal neoplasm. Endocr Pathol 1999;10:256-68.  Back to cited text no. 9
[PUBMED]    
10.
Smallridge RC, Castro MR, Morris JC, Young PR, Reynolds JC, Merino MJ, et al. Renal metastases from thyroid papillary carcinoma: Study of sodium iodide symporter expression. Thyroid 2001;11:795-804.  Back to cited text no. 10
    
11.
Liou MJ, Lin JD, Chung MH, Liau CT, Hsueh C. Renal metastasis from papillary thyroid microcarcinoma. Acta Otolaryngol 2005;125:438-42.  Back to cited text no. 11
    
12.
Varinot J, Ménégaux F, Bitker MO, Compérat E. Renal metastasis from thyroid carcinoma: A case report. Anal Quant Cytopathol Histpathol 2014;36:46-50.  Back to cited text no. 12
    
13.
Lubana SS, Singh N, Tuli SS, Bashir T, Sachmechi I, Kemeny MM. Follicular variant of papillary thyroid cancer with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer: A rare occurrence. Am J Case Rep 2015;16:459-68.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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