title: Tumor-to-tumor metastases: papillary thyroid carcinoma into a clear cell renal cell carcinoma.
abstract: BACKGROUND
  Thyroid metastases to distant sites are uncommon incidents, most often metastasizing to the lungs and bones. Rates of metastasis to the kidney are particularly low, ranging from 2.8-3.8% for papillary and 6-20% for follicular variants of well-differentiated thyroid cancers (WDTCs). In rare instances, tumor-to-tumor metastasis between two true primary neoplasms can occurs. This medical phenomenon has previously occurred as a clear cell renal cell carcinoma (CCRCC) spreading to a WDTC. To our knowledge, this is the first report of a tumor-to-tumor metastasis of a thyroid cancer metastasizing to a primary renal neoplasm.
  
  
  METHODS
  A 72 year old male presented to the urology clinic with complaints of flank pain. Computed tomography (CT) imaging of the abdomen and pelvis revealed a 5.7 cm solid enhancing mass from the lateral aspect of the right kidney, suspicious for renal cell carcinoma (RCC). The patient subsequently underwent a right laparoscopic radical nephrectomy, and immunohistochemical staining of the 5.5 cm lesion revealed a positive RCC marker to establish a diagnosis of a pT1b ISUP Grade 2 CCRCC. The tumor contained a 3 mm focus of a lesion staining positive for TTF1 and Thyroglobulin, and negative for RCC marker. This finding established a diagnosis of a tumor-to-tumor metastasis of PTC to CCRCC. Subsequent ultrasound and CT of the head and neck revealed a heterogeneously hypodense 3.3 cm mass in the right thyroid lobe, prompting a total thyroidectomy and level VI neck dissection. Pathology revealed a classic variant multifocal PTC and two ipsilateral lymph nodes positive for metastatic PTC. Ultimately, the thyroid specimen was positive for lymphatic vascular invasion, extrathyroidal extension with invasion of the tracheal cartilage, staging as T4aN1aM1. On follow up examination the patient was recovering well, without signs of dysphagia or dysphonia, and showed bilateral mobile vocal cords on laryngoscope examination.
  
  
  CONCLUSIONS
  Tumor-to-tumor metastasis between the thyroid and kidney is an extremely rare occurrence, reports of RCC metastases from a WDTC has not yet been reported in the literature. Corroboration of diagnostic imaging findings with immunohistochemistry staining can consolidate a diagnosis of thyroid neoplasm tumor-to-tumor metastasis to a RCC, thereby prompting surgical excision.
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. jasong5963@gmail.com.
authors.forename: Jin Soo Andy
authors.initials: JS
authors.lastname: Song
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: S Mark
authors.initials: SM
authors.lastname: Taylor
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Trites
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Rigby
authors.affiliation: Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Martin Joseph
authors.initials: MJ
authors.lastname: Bullock
authors.affiliation: Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Merrimen
authors.affiliation: Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hart
mesh_terms: D000368:Aged; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D008297:Male; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000628:therapy
keywords: Clear cell renal cell carcinoma; Papillary thyroid carcinoma; Tumor-to-tumor