Synchronous thyroid gland metastases from breast cancer. Case reports

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Background. Breast cancer is the leading cause of death in women. Distant metastases in different organs, including the thyroid gland, are still an urgent problem. Distant metastases are very rare in clinical practice. Nevertheless, the accumulated clinical and surgical experience in treatment has shown that breast cancer is the second most common primary tumor, leading to thyroid gland metastases, after kidney cancer.

Aim. Present the clinical observations of synchronous thyroid gland metastases from breast cancer.

Materials and methods. We observed two patients, aged 55 and 72 years, suffering from metastatic breast cancer with simultaneous metastases to the thyroid gland, to the cervical and mediastinal lymph nodes, to the lungs, to the ovaries and to the bones.

Results. A 55-year-old woman with a left sided neck mass and hoarseness has been suffering from the metastatic breast cancer with simultaneous metastases to the thyroid gland, to the cervical lymph nodes, to the lungs, to the ovaries and to the bones. The biopsy of the primary tumor has been performed. The tumor has the structure of invasive ductal carcinoma, G2, luminal A subtype, HER2-negative type in histological and immunohistochemical analysis. The spread of the tumor has been determined by positron emission tomography/computed tomography (PET/CT). Metastases from breast cancer have been cytologically proven during thin needle biopsy. A 72-year-old woman with a mass in the region of thyroid gland has been suffering from breast cancer with metastases to the thyroid gland, to the mediastinal and cervical lymph nodes, to the bones, and to determine this process PET/CT, the thyroid fine needle aspiration biopsy and core biopsy of primary tumor have been applied. The histological variant was represented by invasive ductal cancer, G2, luminal A subtype, HER-2 negative type. Taking into account the spread of the process, the patients were given polychemotherapy, targeted therapy and hormone therapy. There is no disease progression for 6 months.

Conclusion. Synchronous thyroid gland metastases in case of primary breast tumors are rare. In such cases, PET/CT is the important diagnostic method. The main therapeutic option in this case is systemic therapy, including chemotherapy, targeted and hormone therapy, the nature of the agent depends on the biological variant of the tumor.

作者简介

Nikolai Ognerubov

Derzhavin Tambov State University; Tambov Regional Oncological Clinical Dispensary

编辑信件的主要联系方式.
Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247
SPIN 代码: 3576-3592

D. Sci. (Med.), Cand. Sci. (Law), Prof.

俄罗斯联邦, Tambov; Tambov

Tatyana Antipova

“PET-Technoligy” Ltd; Nuclear Medicine Center

Email: antipovats@gmail.com
ORCID iD: 0000-0003-4165-8397

doctor

俄罗斯联邦, Tambov; Tambov

Elena Palkina

Tambov Regional Oncological Clinical Dispensary

Email: palkina68@mail.ru

cytologist

俄罗斯联邦, Tambov

参考

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2. Fig. 1. A 72-year-old woman before the treatment. MIP and axial positron emission tomography/computed tomography (PET/CT) images show moderate diffuse enlargement of the thyroid gland: the right lobe of the thyroid gland is 10×21 mm, the left lobe of the thyroid gland is 13´22 mm with increased uptake of radiopharmaceutical, SUVmax 10.90. The structure of the thyroid gland during native computed tomography images was homogeneous. The images showed lymph nodes on both sides measuring 8 mm SUVmax 5.48; IIa, IIb groups on the right side and III, IV groups on both sides measuring 13 mm with increased uptake of radiopharmaceutical (RFP), SUVmax 12.93.

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3. Fig. 2. A 72-year-old woman before the treatment. Axial PET/CT images show the lump measuring <11 mm in diameter with the focal increased fludeoxyglucose (FDG) uptake SUVmax 1.33 in the upper outer quadrant of left breast against the background of heterogeneously scirrhous glandular tissue. Regional axillary lymph nodes on the left hand side are single, with cortical thickening measuring 17×8 mm, SUVmax 1.45.

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4. Fig. 3. A 72-year-old woman before the treatment. Axial and sagittal PET/CT images show multiple mediastinal lymph nodes (upper and lower paratracheal, bronchopulmonary on both sides, bifurcation groups of lymph nodes) measuring 15 mm with increased uptake of FDG SUVmax 5.0. In all bone structures of the scanning zone against the background of mixed bone remodeling (mostly blastic lesion, in the sternum – lytic metastatic lesion) with focal increased RFP uptake SUVmax 7.65.

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5. Fig. 4. A 72-year-old woman. The condition of the patient after 6 cycles of targeted and hormone therapy. Axial MIP and PET/CT images show the persisted moderate diffuse enlargement of right and left lobes of the thyroid gland measuring 6×20 mm and 11×22, respectively. RFP uptake is decreased to SUVmax 5.74, previously 10.90.

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6. Fig. 5. A 72-year-old woman. The condition of the patient after 6 cycles of targeted and hormone therapy. Axial MIP and PET/CT images show that lump in the upper outer quadrant of left breast is not differentiated and without focal increased RFP uptake.

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7. Fig. 6. A 72-year-old woman. The condition of the patient after 6 cycles of targeted and hormone therapy. Axial and sagittal PET/CT images show that mediastinal lymph nodes (upper and lower paratracheal, bronchopulmonary on both sides, bifurcation groups of lymph nodes) have become 8 mm, previously 15 mm. The RFP uptake is decreased to baseline, SUVmax 3.64, previously 5.07. In the bones of the skeleton there is an increase in osteosclerotic density against the background of secondary transformation (metastases). The focal hypermetabolism is still detected in the single focal areas of FDG uptake SUVmax 7.77.

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8. Fig. 7. A 55-year-old woman. The aspiration of breast tumor. The cell elements are abundant and represented by numerous papillae-like, gland-like structures of tumor cells of ductal carcinoma. The nuclei have enlarged nucleoli. Romanowsky stain, ×1000.

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9. Fig. 8. A 55-year-old woman. The aspiration of thyroid tumor. Gland-like and papillae-like structures from polymorphic and hyperchromic cell cancers corresponding to ductal carcinoma are detected Romanowsky stain, ×1000.

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10. Fig. 9. A 55-year-old woman. MIP and axial PET/CT images show the enlargement of the thyroid gland tissue on both sides with increased RFP uptake, SUVmax 6.30, the density of tissue is decreased on the right measuring 29×39×52 mm and on the left measuring 38×48×43 mm, the margins are fuzzy.

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11. Fig. 10. A 55-year-old woman. Axial PET/CT images show a lump measuring 20×23 mm in the border in the upper quadrants of left breast with increased FDG uptake SUVmax 6.19 with clear rough margins and homogeneous density.

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12. Fig. 11. A 55-year-old woman. Sagittal PET/CT images show that in the bones of the skeleton are defined multiple focal increased RFP uptake against the background of osteoblastic bone remodeling, SUVmax 4.86.

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