Medical literature about the role of endoscopic ultrasound (EUS) in identifying thyroid lesions is limited. We present a case of secondary thyroid cancer from renal cell carcinoma (RCC) metastasis, diagnosed by thyroid EUS-fine needle aspiration (FNA) approach that was done for staging of esophageal adenocarcinoma, in a patient with 11-year history of complete right nephrectomy for RCC. An 81-year-old female patient underwent EUS for the evaluation of a newly discovered distal esophageal cancer. A hypoechoic, round, and well-demarcated mass that measured 26.9 mm × 21.9 mm was noticed in the right lobe thyroid gland. Therefore FNA was performed. The cytological results were consistent with metastatic RCC. In conclusion, EUS-FNA of thyroid nodule is a feasible and safe technique that can be used to evaluate any suspicious thyroid nodule. This case emphasizes the importance of carefully examining the thyroid gland during routine upper esophageal EUS examinations in the presence of history of nonthyroidal cancer.
Medical literature about the role of endoscopic ultrasound (EUS) in identifying thyroid lesions is limited. We present a case of secondary thyroid cancer from renal cell carcinoma (RCC) metastasis, diagnosed by thyroid EUS-fine needle aspiration (FNA) approach that was done for staging of esophageal adenocarcinoma, in a patient with 11-year history of complete right nephrectomy for RCC.
An 81-year-old female patient presented to our facility with dysphagia to both solids and liquids. For the evaluation of her dysphagia, she underwent esophagogastroduodenoscopy (EGD). Initially, EGD examination of the esophagus revealed a distal esophageal mass of 5 cm in length extending 2 cm inside the gastric cardia, that was biopsied, and the histopathologic results revealed esophageal adenocarcinoma. For staging, the patient underwent computed tomography (CT) of the chest, which showed the lower esophageal mass with mediastinal lymphadenopathy. Next, the patient underwent upper gastrointestinal (GI) EUS for assessment of the esophageal adenocarcinoma and the mediastinal lymph nodes. The endosonographic examination of the esophageal mass was performed with the scope being positioned at the proximal border of the mass. The mass was hypoechoic and heterogeneous and involved three-quarters of the circumference of the esophageal lumen, involving all esophageal wall layers to the adventitia. The EUS-FNA examination of the mediastinal lymph nodes revealed no lymphatic spread. A diagnosis of esophageal adenocarcinoma with stage of T3N0M0 was made. Upon withdrawing the EUS scope, examination of the thyroid revealed hypoechoic, round, and well-demarcated mass that measured 26.9 mm × 21.9 mm in the right lobe (Figure
(a) EUS examination of the thyroid revealed a hypoechoic, round, and well-demarcated mass that measured 26.9 mm × 21.9 mm in the right lobe. (b) Under echoendosonographic guidance, FNA with a 25-gauge needle (Expect EUS-FNA 25 G needle; Boston Scientific, Menomonie, WI, USA) was performed successfully.
(a) Cell block of thyroid nodule FNA is displaying multiple nests of clear cells, which have clear to eosinophilic cytoplasm. These nests are separated by delicate vascular network and surrounded by lymphocytic infiltrate (hematoxylin-eosin stain, original magnification ×400). (b) Staining of cell block with PAX-8 shows strong nuclear positivity (PAX-8 immunohistochemistry stain, original magnification ×200). (c) Staining the cell block with thyroid transcription factor-1 (TTF-1) shows negative staining (TTF-1 immunohistochemistry stain, original magnification ×200). (d) Kidney section is showing multiple nests of clear cells, which have clear to eosinophilic cytoplasm. These nests are separated by delicate vascular network (hematoxylin-eosin stain, original magnification ×400).
Metastatic disease to the thyroid gland is rare, and adenocarcinomas from the kidney, lung, breast, and colon along with squamous cell carcinomas (mainly head and neck) represent the majority of primary sites [
The use of EUS for the diagnosis of thyroid disease was first described in 2001 by Ohshima et al. [
During an upper EUS examination, the thyroid gland is usually visualized close to the upper esophageal sphincter. However, EUS is limited in visualizing the upper portions of the thyroid glands [
In 2015, a multi-institutional study of 62 cases of secondary thyroid cancer showed that FNA biopsy has a sensitivity and specificity of 80% and 93%, respectively [
Informed consent was obtained for this case.
The authors declare that there are no conflicts of interest regarding the publication of this paper.
Yousef Abdel-Aziz did the literature review and wrote the manuscript. Tariq Hammad reviewed and edited the manuscript. Hayder Abdulwahid reviewed and provided the pathology slides. Mohamad Nawras edited the supplied images. Ali Nawras edited the manuscript and is the article guarantor.