Cardiac, choroidal and subcutaneous metastases of a follicular thyroid carcinoma

Full text of publication follows. Aim: to describe an unusual case of follicular carcinoma of the thyroid with uncommon metastases at the left atrium, the pulmonary vessels, the right eye and a subcutaneous mass. Materials and methods: the patient record was reviewed retrospectively. We analysed clinical outcomes and thyroglobulin rate as well as imaging findings after radio-iodine therapy. Results: we report the case of 43-year-old woman operated in 1995 for multi-nodular goitre by total thyroidectomy. Histopathologic findings were typical of follicular thyroid carcinoma with vascular invasion. The patient was then lost of sight and consulted in 2000 for a neck swelling. She was operated again for lymphadenectomy with resection of two peri-jugular tumoral masses that deviate vascular axes. Histopathologic findings concluded for residual follicular thyroid carcinoma with insular component without lymph node metastasis. The initial chest CT revealed a macro-nodular lung miliairy and the whole body scan post 100 mCi Iodine-131 showed intense cervical uptake and multiple bilateral thoracic fixations. The evolution after 10 cures of Iodine-131 has been marked by a persistently high thyroglobulin levels superior to 800 ng/ml with disappearance of cervical uptake and the persistence of pulmonary fixations. Bone scintigraphy scan was negative. Later, the patient complained of a decreased visual acuity. The last whole body SPECT/CT scan revealed multiple fixations of I-131 located at the right eyeball, lungs, left atrium, liver, sacrum as well as an abdominal subcutaneous solid mass. MRI confirmed a right choroid metastasis. Conclusion: follicular thyroid carcinoma comprises 15% of all thyroid cancers and usually metastases to the lymph nodes, lungs and bone. Other rare sites of metastases are the brain, pituitary, maxilla, larynx, and thymus. Distant metastases of these sites, particularly choroidal are exceptional. Metastatic cardiac involvement occurs most often during the terminal stage. They are frequently asymptomatic, but when symptoms develop these tend to be severe and often fatal. To our knowledge, only a few cases have been reported in the entire literature. Our case is unique in the presence of metastases in cardiac, choroidal and subcutaneous sites. We highlight the contribution of the SPECT/CT in the assessment of these distant metastases. (authors)