|Year : 2014 | Volume
| Issue : 2 | Page : 131-132
Papillary carcinoma thyroid, metastasis to cheek: First ever reported case in literature
Aiffa Aiman, Farhat Mustafa, Mir Yasir, Tazeen Jeelani, Summat Khurshid
Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||20-May-2014|
Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Papillary thyroid carcinoma (PTC) metastasis to distant organs is rare and mainly includes lung and bone. Metastasis affecting oral and maxillofacial region is extremely rare. We describe a case of PTC metastasis to cheek. The patient presented with a painless swelling of the left cheek with a history of total thyroidectomy for papillary carcinoma thyroid 5 years back. Cheek metastasis from papillary carcinoma thyroid is extremely rare. To the best of our knowledge, this is the first recorded instance of cheek metastasis from PTC. Common malignancies can metastasize to unusual sites and although infrequent, may be the presenting feature. The successful management of such cases may be achieved by a multidisciplinary approach.
Keywords: Papillary thyroid carcinoma, thyroid malignancy, thyroid neoplasm
|How to cite this article:|
Aiman A, Mustafa F, Yasir M, Jeelani T, Khurshid S. Papillary carcinoma thyroid, metastasis to cheek: First ever reported case in literature. J Sci Soc 2014;41:131-2
|How to cite this URL:|
Aiman A, Mustafa F, Yasir M, Jeelani T, Khurshid S. Papillary carcinoma thyroid, metastasis to cheek: First ever reported case in literature. J Sci Soc [serial online] 2014 [cited 2020 Aug 11];41:131-2. Available from: http://www.jscisociety.com/text.asp?2014/41/2/131/132862
| Introduction|| |
Papillary thyroid carcinoma (PTC) is the most common form of thyroid malignancy with a good prognosis, since it is generally confined to the neck with or without spread to regional lymph nodes.  However, distant metastasis is rare and mainly includes lung and bone.  Metastasis affecting oral and maxillofacial (OMF) region is extremely rare, occurring in 0.2% of all cases of thyroid carcinoma. 
| Case report|| |
The present case report is about a 65-year-old male patient who presented to us with a painless swelling of the left cheek of 2 weeks duration, progressively increasing in size. Patient had a past history of total thyroidectomy done in 2008 for papillary carcinoma thyroid.
Physical examination revealed a 3 cm × 2 cm non-tender firm swelling in the left cheek with left cervical lymphadenopathy. Computed tomographic scan revealed a well-defined 3 cm × 2 cm mass over the left parotid space. The tumor was noted to be displacing the left masseter muscle laterally with obliteration of the medial border. Fine-needle aspiration cytology (FNAC) of this left cheek mass revealed tumor cells arranged in papillae, individual tumor cells showed intra nuclear inclusions and nuclear grooving. Features were consistent with metastatic deposits of papillary carcinoma thyroid [Figure 1]. FNAC of the left cervical nodes also revealed features of metastatic papillary carcinoma thyroid.
|Figure 1: Tumor cells arranged in papillary confi guration with occasional intra-nuclear inclusions (MGG, ×40)|
Click here to view
The patient initially presented with swelling right side neck of 2 months duration in June 2008. Thyroid profile (T3, T4, thyroid-stimulating hormone) was within the normal limits. Iodine scan revealed significant uptake corresponding to right cervical lymph node. Ultrasound of the thyroid revealed a hypoechoic lesion measuring 3 cm × 2 cm, having ill-defined margins in the right lobe of thyroid. In addition, punctate calcification was also seen suggestive of psammoma bodies. Ultrasound abdomen was normal. Kidney function tests, liver function tests were within the normal limits. FNAC of the swelling was done and a diagnosis of papillary carcinoma thyroid (Bethesda VI) was made [Figure 2]. Subsequently the patient underwent total thyroidectomy with right sided block dissection of nodes. Histopathology confirmed the diagnosis of papillary carcinoma thyroid.
|Figure 2: Tumor cells showing prominent intranuclear inclusions (MGG, ×40)|
Click here to view
| Discussion|| |
Approximately 90% of malignant thyroid tumors are well-differentiated and are classified as PTC (80%) or follicular carcinoma (10%).  A minority of patients with papillary carcinoma thyroid may present, or subsequently develop, locoregional and distant metastasis that may adversely affect survival.  Distant metastasis occur in 4-8% of patients with PTC. ,,, Most common distant metastasis is to lung followed by bone. Metastatic thyroid carcinomas rarely involve the OMF region. They constitute 5.8% of all OMF metastasis and are usually located in the jaw bones. 
To the best of our knowledge, this is the first recorded instance of a cheek metastasis from PTC.
The patient refused surgery of any sort at the very onset and has been planned for radio-iodine therapy followed by optimal radiotherapy. This may provide a better prognosis because of the enhanced uptake and increased effectiveness of post-operative radioiodine in dealing with other systemic micrometastases that are otherwise undetectable. ,
Common malignancies can metastasize to unusual sites and, although infrequent, may be the presenting feature. Although uncommon, OMF lesions can be the first manifestation of a differentiated thyroid carcinoma. This is the first report of a PTC presenting as a metastasis to cheek. The successful management of such cases may be achieved by a multidisciplinary approach.
| References|| |
|1.||Jossart GH, Clark OH. Well-differentiated thyroid cancer. Curr Probl Surg 1994;31:933-1012. |
|2.||Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: Benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 2006;91:2892-9. |
|3.||Shen ML, Kang J, Wen YL, Ying WM, Yi J, Hua CG, et al. Metastatic tumors to the oral and maxillofacial region: A retrospective study of 19 cases in West China and review of the Chinese and English literature. J Oral Maxillofac Surg 2009;67:718-37. |
|4.||Pelizzo MR, Boschin IM, Toniato A, Piotto A, Pagetta C, Gross MD, et al. Papillary thyroid carcinoma: 35-year outcome and prognostic factors in 1858 patients. Clin Nucl Med 2007;32:440-4. |
|5.||Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: Clinical features, prognostic factors, treatment, and survival. Cancer 2003;97:1181-5. |
|6.||Lin JD, Hsueh C, Huang BY. Papillary thyroid carcinoma with different histological patterns. Chang Gung Med J 2011;34:23-34. |
|7.||Chang HY, Lin JD, Chou SC, Chao TC, Hsueh C. Clinical presentations and outcomes of surgical treatment of follicular variant of the papillary thyroid carcinomas. Jpn J Clin Oncol 2006;36:688-93. |
|8.||Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am 1995;24:761-801. |
[Figure 1], [Figure 2]