English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background  Macrofollicular variant of papillary thyroid carcinoma (MFV-PTC) is a rare subtype with histological features and an indolent clinical course that can be confused with nodular goiter or follicular adenoma. However, on rare occasions it may show more aggressive biological behavior. Only two cases of MFV-PTC with bone metastases have been reported previously. We describe the clinical-pathological characteristics of a man with MFV-PTC that developed femur metastasis. This the first case of MFV-PTC with femur metastases diagnosed histologically by means of an image-guided core needle biopsy in English literature.    Case presentation  A 33-year-old man presented two years earlier with swelling in the right neck associated with weight loss and pain in the left knee. Neck ultrasonography showed hyperechogenic and hypogenic nodular images in the thyroid’s right lobe. A fine needle aspiration biopsy specimen was initially interpreted as nodular hyperplasia. A CT showed a large tumor involving right thyroid lobe with trachea and vascular structures displaced to the right, and a total thyroidectomy was performed. Subsequently, a MRI of the knee confirmed the presence of a destructive tumor in the femur. A guided core-needle biopsy of the knee tumor showed the presence of metastatic MFV-PTC. Re-assessment of the histology from thyroidectomy was also consistent with MFV-PTC. A whole-body  18 F-FDG PET/CT showed presence of lesions in the left anterior costal arch, metaphysis of the left femur and in the sternum handle. Therefore, he received 200 mCi radioactive iodine, and 40 Gy of radiotherapy to left costal arches and knee, which decreased his symptoms. Currently, after 10 months of follow-up, the patient is alive with bone tumor activity.    Conclusions  Our case supports the view that, on rare ocassions, MFV-PTC may show a more aggressive biological behavior than expected. The synchronous or asynchronous presence of one or more bone lesions, should raise the suspicion of metastasis. Given the suspicion, it is necessary to take a biopsy to confirm histologically. Only a careful analysis of the architectural and cytological characteristics of goiter or hyperplastic nodules will allow to recognize this rare variety of carcinoma.

Macrofollicular variant of papillary thyroid carcinoma with metastasis to femur