Axillary node metastasis from differentiated thyroid carcinoma with Hürthle and signet ring cell differentiation. A case of disseminated thyroid cancer with peculiar histologic findings.
BACKGROUND
Differentiated thyroid cancer is usually associated with an excellent prognosis and indolent course. Distant metastases are rare events at the onset of thyroid cancer. Among these presentations, metastasis to the axillary lymph nodes is even more unusual: only few cases were previously reported in the literature; there has been no report of axillary lymph node metastasis from follicular thyroid carcinoma. Axillary lymph node metastasis generally arises in the context of disseminated disease and carries an ominous prognosis.


METHODS
Here we present a case of axillary lymph node metastasis in the context of disseminated differentiated thyroid cancer. The patient underwent near total thyroidectomy and neck and axillary lymph node dissection. A histopathological diagnosis of poorly differentiated follicular carcinoma with "signet ring cells" and Hürthle cell features was established. The patient received radioactive iodine therapy and TSH suppression therapy. Subsequently his serum thyroglobulin level decreased to 44.000 ng/ml from over 100.000 ng/ml.


CONCLUSIONS
Currently there are only few reported cases of axillary node metastases from thyroid cancer, and to our knowledge, this is the first report on axillary lymph node metastasis from follicular thyroid carcinoma. "Signet ring cell" is a morphologic feature shared by both benign and, more rarely, malignant follicular thyroid neoplasm, and it generally correlates with an arrest in folliculogenesis. Our case is one of the rare "signet ring cells" carcinomas so far described.
Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Naples, Italy.
Maria Grazia
MG
Chiofalo
Nunzia Simona
NS
Losito
Franco
F
Fulciniti
Sergio Venanzio
SV
Setola
Antonio
A
Tommaselli
Ugo
U
Marone
Maria Luisa
ML
Di Cecilia
Luciano
L
Pezzullo
D018249:Adenoma, Oxyphilic; D000368:Aged; D002291:Carcinoma, Papillary / Q000556:secondary*; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D013964:Thyroid Neoplasms / Q000473:pathology*