EP122 – Skin metastasis on the neck: an unusual presentation of recurrence of papillary thyroid carcinoma

      Soylu, Selen¹; Arikan, Akif Enes¹; Teksoz, Serkan¹; Ozcan, Murat¹; Bukey, Yusuf¹ 1 Istanbul University Cerrahpasa Medical Faculty, General Surgery, Istanbul, Turkey   Purpose: Skin metastasis of papillary thyroid carcinoma is rare (1). Here, two cases of skin metastases of papillary thyroid cancer (PTC) are presented. Methods: Eighty three and 65 year-old female patients were admitted to the hospital with a firm mobile palpable skin lesion on anterior neck region. Free T3 and T4 were in normal levels and TSH levels low in both patients. Both patients had undergone total thyroidectomy due to PTC and had received iodine 131 ablation therapy and then thyroid suppression therapy. After 5 and 3 years of disease free period respectively, skin metastasis occurred in both patients. Results: Thyroid ultrasonography of both patients showed hypoechoic nodules with central vascularisation. In their histological examination, cystic lesions filled with papillary structures were seen. Their fine needle aspiration biopsy were papillary carcinoma.  The excisional biopsy result was PTC with solid trabecular pattern. Discussion: Papillary thyroid carcinoma tends to metastasize to regional lymph nodes but distant metastasis is rare (2). When distant metastasis such as skin develops, prognosis of the disease is poor (3). If the patient does not have a thyroid malignancy history, diagnosis of papillary thyroid carcinoma metastatic to the skin may be difficult since primary skin tumors such as apocrine tumors have similar histopathological features (4). But in the presented two cases since there was a papillary thyroid carcinoma history, the diagnosis was easier with the help of histopathological examination. Conclusion: Skin metastasis of PTC should be kept in mind when differential diagnosis of atypical skin lesions are made especially in the patients with malignancy history.   References:
    1. Alwaheeb S, Ghazarian D, Boerner S L, Asa S L. Cutaneous manifestations of thyroid cancer: a report of four cases and review of the literature Journal of Clinical Pathology 2004;57:435-438.
    2. Dahl P, Brodland D, Goellner J., Hay I. Thyroid carcinoma metastatic to the skin: A cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol 1997;36:531-7.
    3. Horiguchi Y, Takahashi C, Imamura S. Cutaneous metastasis from papillary carcinoma of the thyroid gland: report of two cases. J Am Acad Dermatol 1984;10:988-92.3.
    4. Romanelli, P; Mejias, A; Isaac, G; Sasken, H American Cutaneous metastasis from papillary thyroid carcinoma. Journal of Dermatopathology: February 1994 – Volume 16 – Issue 1 – ppg 102.


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