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Thoracic Wall Metastasis from an Occult Thyroid Follicular Carcinoma

Nadeesha Jeewan Nawarathna, Nawam R Kumarasinghe, Deepthika Chandrasekara, Rasika Shamalie Balasooriya, Palitha Rathnayake, Aruna A Shaminda, Maujud M Rizmy and Ranjith JK Senevirathne

Occult thyroid carcinoma presenting with clinically apparent metastasis is rare and is a diagnostic challenge. Here we report a 68 year old male who presented with a left side chest wall mass of one year duration. The mass showed rapid enlargement at the latter end of its course, following an initial asymptomatic period. Imaging studies showed a soft tissue mass eroding into several ribs.Wide local excision with primary reconstruction was performed.Histological studies and immune staining revealed metastasis from a follicular thyroid carcinoma. Total thyroidectomy followed, confirming the diagnosis. Post-operatively radio isotope ablation (I131) was done.A suppression dose of thyroxin was continued with regular thyroglobulin assays. Painful bone responded well to analgesics, bisphosphonates and external beam radiotherapy. Follicular carcinoma comprise 10-15% of
thyroid malignancies. Localized thyroid carcinoma has a very good prognosis, ten year survival rates reducing by 50% with metastatic disease. Commonly thyroid cancer presents as detectable thyroid nodules, 25% having metastasis. In contrast metastatic manifestations are reported in less than 5% of occult thyroid cancers.