SPINAL COMPRESSION FRACTURE AND WIDESPREAD METASTATIC LESIONS: A RARE PRESENTATION OF FOLLICULAR THYROID CARCINOMA
AACE ePoster Library. Madala S. 05/13/15; 97819; 1009
Sravanthi Madala
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Abstract
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Objective: Follicular Thyroid Carcinoma is a condition most commonly limited to the thyroid. Initial presentation of this condition as widespread metastatic disease is a rare phenomenon.
Results or Case Presentation: A 73 year old Jamaican female with history significant for multinodular goiter and left hemi thyroidectomy 8 years ago for an atypical follicular adenoma, presented with a 2 month history of 15 lb weight loss, progressive left leg weakness, back pain and a new-onset gait disturbance. On exam she had an unsteady gait and a positive Babinski sign on the left lower extremity. MRI of the spine showed multiple lesions concerning for metastatic disease as well as a 3.6x3.3x2.8 cm enhancing mass on T1 causing severe spinal stenosis with cord compression at the level of T8. She was treated with intravenous steroids and decompression and stabilization of her spine. Pathology of the spinal mass showed follicular thyroid carcinoma. Further staging revealed multiple areas of skeletal metastatic disease. Thyroid ultrasound showed multiple mixed solid and cystic nodules in the right lobe with the dominant nodule measuring 1.0 x 0.9 x 0.5cm. The patient underwent external beam radiation for her spinal lesion followed by a right completion thyroidectomy. Interestingly, final pathology of her right thyroid lobe did not show any evidence of follicular carcinoma. Genetic testing on the spinal lesion was positive for NRAS, PIK3CA, KIT and TP53 mutations. Further management included treatment with levothyroxine and radioactive iodine.
Discussion: This case illustrates the potential for extensive metastases from follicular thyroid carcinoma (FTC), a common thyroid cancer in which extra-nodal metastases are uncommon. Vascular invasion with skeletal metastases has been reported in only approximately 10% of FTCs. Studies have shown that some thyroid nodules, such as the excised atypical thyroid adenoma in this patient, may have malignant potential. Through genetic fine-tuning, driving somatic gene mutations may regulate fundamental characteristics of FTCs, such as differentiation, invasion and metastasis. Mutations of the RAS and TP53 genes are some mutations that have been associated with rare aggressive and invasive forms of disease, such as the metastatic follicular thyroid carcinoma seen in this patient.
Conclusion: Early molecular testing of thyroid tumors can demonstrate malignant potential and may assist in timely management and prevention of significant morbidity and mortality.
Results or Case Presentation: A 73 year old Jamaican female with history significant for multinodular goiter and left hemi thyroidectomy 8 years ago for an atypical follicular adenoma, presented with a 2 month history of 15 lb weight loss, progressive left leg weakness, back pain and a new-onset gait disturbance. On exam she had an unsteady gait and a positive Babinski sign on the left lower extremity. MRI of the spine showed multiple lesions concerning for metastatic disease as well as a 3.6x3.3x2.8 cm enhancing mass on T1 causing severe spinal stenosis with cord compression at the level of T8. She was treated with intravenous steroids and decompression and stabilization of her spine. Pathology of the spinal mass showed follicular thyroid carcinoma. Further staging revealed multiple areas of skeletal metastatic disease. Thyroid ultrasound showed multiple mixed solid and cystic nodules in the right lobe with the dominant nodule measuring 1.0 x 0.9 x 0.5cm. The patient underwent external beam radiation for her spinal lesion followed by a right completion thyroidectomy. Interestingly, final pathology of her right thyroid lobe did not show any evidence of follicular carcinoma. Genetic testing on the spinal lesion was positive for NRAS, PIK3CA, KIT and TP53 mutations. Further management included treatment with levothyroxine and radioactive iodine.
Discussion: This case illustrates the potential for extensive metastases from follicular thyroid carcinoma (FTC), a common thyroid cancer in which extra-nodal metastases are uncommon. Vascular invasion with skeletal metastases has been reported in only approximately 10% of FTCs. Studies have shown that some thyroid nodules, such as the excised atypical thyroid adenoma in this patient, may have malignant potential. Through genetic fine-tuning, driving somatic gene mutations may regulate fundamental characteristics of FTCs, such as differentiation, invasion and metastasis. Mutations of the RAS and TP53 genes are some mutations that have been associated with rare aggressive and invasive forms of disease, such as the metastatic follicular thyroid carcinoma seen in this patient.
Conclusion: Early molecular testing of thyroid tumors can demonstrate malignant potential and may assist in timely management and prevention of significant morbidity and mortality.
Objective: Follicular Thyroid Carcinoma is a condition most commonly limited to the thyroid. Initial presentation of this condition as widespread metastatic disease is a rare phenomenon.
Results or Case Presentation: A 73 year old Jamaican female with history significant for multinodular goiter and left hemi thyroidectomy 8 years ago for an atypical follicular adenoma, presented with a 2 month history of 15 lb weight loss, progressive left leg weakness, back pain and a new-onset gait disturbance. On exam she had an unsteady gait and a positive Babinski sign on the left lower extremity. MRI of the spine showed multiple lesions concerning for metastatic disease as well as a 3.6x3.3x2.8 cm enhancing mass on T1 causing severe spinal stenosis with cord compression at the level of T8. She was treated with intravenous steroids and decompression and stabilization of her spine. Pathology of the spinal mass showed follicular thyroid carcinoma. Further staging revealed multiple areas of skeletal metastatic disease. Thyroid ultrasound showed multiple mixed solid and cystic nodules in the right lobe with the dominant nodule measuring 1.0 x 0.9 x 0.5cm. The patient underwent external beam radiation for her spinal lesion followed by a right completion thyroidectomy. Interestingly, final pathology of her right thyroid lobe did not show any evidence of follicular carcinoma. Genetic testing on the spinal lesion was positive for NRAS, PIK3CA, KIT and TP53 mutations. Further management included treatment with levothyroxine and radioactive iodine.
Discussion: This case illustrates the potential for extensive metastases from follicular thyroid carcinoma (FTC), a common thyroid cancer in which extra-nodal metastases are uncommon. Vascular invasion with skeletal metastases has been reported in only approximately 10% of FTCs. Studies have shown that some thyroid nodules, such as the excised atypical thyroid adenoma in this patient, may have malignant potential. Through genetic fine-tuning, driving somatic gene mutations may regulate fundamental characteristics of FTCs, such as differentiation, invasion and metastasis. Mutations of the RAS and TP53 genes are some mutations that have been associated with rare aggressive and invasive forms of disease, such as the metastatic follicular thyroid carcinoma seen in this patient.
Conclusion: Early molecular testing of thyroid tumors can demonstrate malignant potential and may assist in timely management and prevention of significant morbidity and mortality.
Results or Case Presentation: A 73 year old Jamaican female with history significant for multinodular goiter and left hemi thyroidectomy 8 years ago for an atypical follicular adenoma, presented with a 2 month history of 15 lb weight loss, progressive left leg weakness, back pain and a new-onset gait disturbance. On exam she had an unsteady gait and a positive Babinski sign on the left lower extremity. MRI of the spine showed multiple lesions concerning for metastatic disease as well as a 3.6x3.3x2.8 cm enhancing mass on T1 causing severe spinal stenosis with cord compression at the level of T8. She was treated with intravenous steroids and decompression and stabilization of her spine. Pathology of the spinal mass showed follicular thyroid carcinoma. Further staging revealed multiple areas of skeletal metastatic disease. Thyroid ultrasound showed multiple mixed solid and cystic nodules in the right lobe with the dominant nodule measuring 1.0 x 0.9 x 0.5cm. The patient underwent external beam radiation for her spinal lesion followed by a right completion thyroidectomy. Interestingly, final pathology of her right thyroid lobe did not show any evidence of follicular carcinoma. Genetic testing on the spinal lesion was positive for NRAS, PIK3CA, KIT and TP53 mutations. Further management included treatment with levothyroxine and radioactive iodine.
Discussion: This case illustrates the potential for extensive metastases from follicular thyroid carcinoma (FTC), a common thyroid cancer in which extra-nodal metastases are uncommon. Vascular invasion with skeletal metastases has been reported in only approximately 10% of FTCs. Studies have shown that some thyroid nodules, such as the excised atypical thyroid adenoma in this patient, may have malignant potential. Through genetic fine-tuning, driving somatic gene mutations may regulate fundamental characteristics of FTCs, such as differentiation, invasion and metastasis. Mutations of the RAS and TP53 genes are some mutations that have been associated with rare aggressive and invasive forms of disease, such as the metastatic follicular thyroid carcinoma seen in this patient.
Conclusion: Early molecular testing of thyroid tumors can demonstrate malignant potential and may assist in timely management and prevention of significant morbidity and mortality.
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