A 65-year-old male patient presented with multiple raised lesions over chest and neck since 1 year associated with loss of weight in this period. He gave history of partial thyroidectomy for papillary carcinoma of thyroid 5 years back. General and systemic examination was unremarkable except for presence of cervical and axillary lymphadenopathy. Cutaneous examination revealed multiple firm to hard, nontender, erythematous to skin colored nodules of variable sizes ranging from 1 × 1 cm to 5 × 4 cm, present over chest [Figure 1] and left side of neck [Figure 2]. Ulceration and bleeding [Figure 3] was seen on few nodules over chest and neck. Rest of the cutaneous examination was normal. Histopathology from chest lesion revealed well-formed tubular structures with colloid like material and columnar cells that was suggestive of papillary carcinoma of thyroid [Figure 4a and b]. Based on history, clinical and histopathological features a diagnosis of cutaneous metastasis from papillary carcinoma of thyroid was made. High resolution Computed Tomography of chest revealed multiple metastatic nodules in bilateral lung parenchyma. The presence of distant lesions on abdomen and chest along with presence of pulmonary metastasis was indicative of hematogenous spread of cancer although there was no histopathological evidence of angioinvasion suggesting the same. Genetic analysis for BRAF mutation and special staining of histopathology section with TTF-1, cytokeratin 7 etc., could not be done in this case due to lack of financial resources. The patient was then referred to department of radiotherapy and oncology for further palliative treatment.
Figure 1.
Multiple firm to hard, nontender, erythematous to skin colored nodules of variable sizes ranging from 1 × 1cm to 5 × 4cm were present over chest
Figure 2.
Large nodular lesions over left side of neck
Figure 3.
Ulceration and bleeding was seen on few nodules over chest and abdomen
Figure 4.
Histopathologyfrom chest lesion with H and E staining at 10× (a) and 40× (b) magnification revealed well-formed tubular structures with colloid like material and columnar cells
Papillary carcinoma is the most common thyroid malignancy with skin metastasis and scalp is the most common site of involvement.[1,2] Cutaneous metastasis is a rare manifestation of systemic malignancies and it signifies advanced disease with grave prognosis.[3] Sometimes, it can be the only presenting sign in cases of occult carcinoma. Therefore, a high index of suspicion for cutaneous metastasis should be kept in patients presenting with abrupt onset of papules or nodules present over a localised area which are rapidly progressing but relatively asymptomatic.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Dahl PR, Brodland DG, Goellner JR, Hay ID. Thyroid carcinoma metastatic to the skin: A cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol. 1997;36:531–7. doi: 10.1016/s0190-9622(97)70239-1. [DOI] [PubMed] [Google Scholar]
- 2.Kwon H, Kim H, Park S, Song DE, Kim WG, Kim TY, et al. Solitary skin metastasis of papillary thyroid carcinoma. Endocrinol Metab (Seoul) 2014;29:579–83. doi: 10.3803/EnM.2014.29.4.579. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Alwaheeb S, Ghazarian D, Boerner SL, Asa SL. Cutaneous manifestations of thyroid cancer: A report of four cases and review of the literature. J Clin Pathol. 2004;57:435–8. doi: 10.1136/jcp.2003.012922. [DOI] [PMC free article] [PubMed] [Google Scholar]