PubMed · 10396295
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P R Simpson. 1999. Frozen section? Just do it.. https://doi.org/10.1093/ajcp%2F112.1.124
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BACKGROUND: Cutaneous metastases from differentiated thyroid carcinoma are rare: only 41 cases have been reported in the literature. CASE REPORT: A 57-year-old woman underwent total thyroidectomy for a poor differentiated follicular thyroid carcinoma, with involvement of sternum and pulmonary metastases. Despite iodine-131 ablative therapy (> 1 Ci) she developed a skin metastasis of the scalp 9 years after the initial surgery. She died of widely metastatic thyroid carcinoma. DISCUSSION: Follicular carcinoma has a greater preponderance than papillary carcinoma for cutaneous metastases. The majority of skin metastases are localized to the head and neck. The development of a cutaneous metastasis is commonly associated with metastasis to other distant tissues and is followed by a deteriorating course and eventual death resulting from malignancy.
Chromosomal translocations that encode fusion oncoproteins have been observed consistently in leukemias/lymphomas and sarcomas but not in carcinomas, the most common human cancers. Here, we report that t(2;3)(q13;p25), a translocation identified in a subset of human thyroid follicular carcinomas, results in fusion of the DNA binding domains of the thyroid transcription factor PAX8 to domains A to F of the peroxisome proliferator-activated receptor (PPAR) gamma1. PAX8-PPARgamma1 mRNA and protein were detected in 5 of 8 thyroid follicular carcinomas but not in 20 follicular adenomas, 10 papillary carcinomas, or 10 multinodular hyperplasias. PAX8-PPARgamma1 inhibited thiazolidinedione-induced transactivation by PPARgamma1 in a dominant negative manner. The experiments demonstrate an oncogenic role for PPARgamma and suggest that PAX8-PPARgamma1 may be useful in the diagnosis and treatment of thyroid carcinoma.
Treatment options in patients with bone metastases of differentiated thyroid carcinoma are limited and mostly aimed at palliation. Conventional treatment modalities are: radioiodine therapy, surgery or external irradiation. A lesser known option is selective embolization of tumour metastases. During selective catheterization of the arteries that feed the metastases embolization material (e.g. polyvinyl alcohol particles) is injected into the local vasculature under radiographic control. The embolization is immediately evaluated angiographically. This therapy was used in three patients with differentiated thyroid carcinoma, a 60-year-old man suffering from back ache, paresis and afterwards paralysis of the lower body parts with incontinence, and in two women aged 59 years (suffering from diplopia and a pelvic metastasis) and aged 27 years (suffering from neurological symptoms or pain of the right leg due to a pelvic metastasis). In all three the symptoms disappeared after the embolization and ensuing treatment with radioactive iodine. Due to recurrent increase in serum thyroglobulin concentration repeated re-embolization was necessary, but during a follow-up period of 3-5 years the palliation remained adequate. Selective embolization appears to be a safe and efficacious treatment, with good tolerability for the patient. Embolization alone or preferably preceded by radioiodine therapy may lead to decreased tumour progression and often gives rise to immediate relief of symptoms.