1. An interesting thyroid noduleAn interesting thyroid nodule
Dr Nidhi BhattDr Nidhi Bhatt
St Georges Hospital
May 2006

2. Case History
 66 y, male
 Multinodular goitre- two nodules felt
 Long standing, painless
 No other history provided
 FNA
 Cellular follicular lesion
 Excision advised

3. Macroscopic specimen
 Lobectomy specimen 78g and 80x50x35
mm
 Lobulated surface
 Multiple nodules on C/S-
 Well-circumscribed
 Encapsulated
 Cream-coloured homogenous
 Occ. foci of haemorrhage

4. Dilated thin-
walled
central
blood
vessels
Closely
packed
nestsof
clearcells

5. Adjacent
normal
thyroid
follicles
Encapsulatio
n

6. Clear cytoplasm,
angulated
nuclei, mild
nuclear
pleomorphism
Fibrovascular stroma
with delicate septa

7. Differential Diagnoses
Clear cell change in
1º thyroid tumours
Parathyroid
neoplasms
Metastatic renal
clear cell
carcinoma

8. Further steps
Clinical correlation
Histochemical stains
Immunostains

9. Special stains
 PAS +/- diastase
 Thyroglobulin
 TTF-1
 CAM
 CK7/20
 Vimentin
 CD10
 Calcitonin

10. TTF -Ve

11. CD10 +ve

12. Vimentin +ve

13. Other results
 Cytoplasmic PAS-positive globules
 CK7/ 20 -ve
 CAM 5.2 +ve
 Thyroglobulin -ve
 Calcitonin -ve
 Neuroendocrine markers -ve

14. Metastatic clear cellMetastatic clear cell
renal carcinomarenal carcinoma

15. Case discussed at the head &
neck MDT
Renal tumour removed 25 years ago in
1984, diagnosed as Clear cell carcinoma,
G2, pT2

16. Further Ix
 No metastases in other organs
 No lymph nodes
 Other kidney normal

17. Arch Pathol Lab Med 1998;122(1):37-41, Cancer 1997;79(3
Discussion
 Intrathyroidal mets do occur
 0.6-1.2 % in thyroidectomies
 0.5-24% at autopsy
 Most common primary sites
 Lung (16-43%)
 Kidney (5.5-33%)
 Breast (1-16%)
 Stomach (8%)
 Uterus (7%)

18. Contd…
 Average interval
 0-19 years
 25 years in the present case
 Prognosis depends on
 Primary site
 Completeness of resection
 Rx
 Thyroidectomy to avoid morbidity of tumour
recurrence in neck

19. Moral of the story
New thyroid mass in a patient with previous
history of malignancy
Think of
metastatic
deposits

20. When in doubt,When in doubt,
take the case to MDMtake the case to MDM !!

21. References
 Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatis disease to the thyroid gland. World J Surg 1999;23(2):177-80
 Dequanter D, Lothaire P, Larsimont D etal. Intrathyroid metastasis:11 cases Ann Endocrinol (Paris) 2004;65(3):205-8
 Lam KY, Lo CY. Metastatic tumours of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med 1998;122(1):37-41
 Nakhjavani MK, Gharib H, Goelner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer 1997;79(3):574-8