title: Late-onset metastasis of renal cell carcinoma into a hot thyroid nodule: an uncommon finding not to be overlooked.
abstract: We report the case of a 74-year-old man with a four-year history of right nephrectomy for clear cell renal carcinoma (CCRC) who was diagnosed with hyperthyroidism. On ultrasound (US), a 5 cm solid isohypoechoic nodule with intranodular vascularization was found in the left thyroid lobe. The nodule was deemed autonomous on (99m)Tc thyroid scan. Methimazole was started and serum thyroid hormone levels quickly normalized; euthyroidism was maintained with a very low dosage of antithyroid drug. Over time, compressive symptoms and local pain occurred and US revealed growth of the nodule. Total thyroidectomy was performed and the combined histological and immunohistochemical evaluation deemed the nodule compatible with metastasis of CCRC; on 2-year follow-up, no tumor relapse was ascertained. In patients with a history of cancer, a thyroid nodule, even if hyperfunctioning, must be suspected of being a metastasis and investigated. Hot nodules, which are largely benign, may be vulnerable to metastatic colonization owing to their rich vascularization. In these cases, surgery may be curative.
authors: Internal Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
authors: Luca
authors: L
authors: Foppiani
authors: Nuclear Medicine, Galliera Hospital, Genoa, Italy.
authors: Michela
authors: 0000-0002-0251-9178
authors: M
authors: Massollo
authors: Endocrinology, Galliera Hospital, Genoa, Italy.
authors: Patrizia
authors: P
authors: Del Monte
authors: Unit of Pathology, Galliera Hospital, Genoa, Italy.
authors: Roberto
authors: R
authors: Bandelloni
authors: Surgery, Galliera Hospital, Genoa, Italy.
authors: Anselmo
authors: A
authors: Arlandini
authors: Nuclear Medicine, Galliera Hospital, Genoa, Italy.
authors: Arnoldo
authors: 0000-0002-6779-1471
authors: A
authors: Piccardo
references: Chirurg. 2003 Aug;74(8):768-74
references: 12928802
references: Cancer. 1997 Feb 1;79(3):574-8
references: 9028370
references: Clin Endocrinol (Oxf). 2007 Apr;66(4):565-71
references: 17371476
references: Cancer. 2002 Nov 1;95(9):1869-78
references: 12404280
references: Urol Clin North Am. 1994 Nov;21(4):589-92
references: 7974891
references: World J Surg. 1999 Feb;23(2):177-80; discussion 181
references: 9880428
references: Thyroid. 2012 Mar;22(3):258-68
references: 22313412
references: Auris Nasus Larynx. 2004 Mar;31(1):95-100
references: 15041062
references: Anticancer Res. 2009 Feb;29(2):473-6
references: 19331189
references: Eur J Surg Oncol. 2004 Aug;30(6):583-8
references: 15256229
references: J Med Case Rep. 2013 Dec 10;7:265
references: 24325865
references: J Endocrinol Invest. 2005 Mar;28(3):294-5
references: 15952416
references: Am J Clin Oncol. 2015 Aug;38(4):338-42
references: 23799287