Thoracic Wall Metastasis from an Occult Thyroid Follicular Carcinoma Nadeesha Jeewan Nawarathna 1* , Nawam R Kumarasinghe 2 , Deepthika Chandrasekara 1 , Rasika Shamalie Balasooriya 3 , Palitha Rathnayake 4 , Aruna A Shaminda 2 , Maujud M Rizmy 1 and Ranjith JK Senevirathne 5 1 Registrar in Surgery, Teaching Hospital, Kandy, Mawanella, Sri Lanka 2 Senior Registrar in Surgery, Teaching Hospital, Kandy, Mawanella, Sri Lanka 3 University of peradeniya, Galaha Road, Peradeniya, Sri Lanka 4 Consultant Pathologist, Teaching Hospital, Kandy, Mawanella, Sri Lanka 5 Consultant Surgeon, Teaching Hospital, Kandy, Mawanella, Sri Lanka * Corresponding author: Nadeesha Jeewan Nawarathna, MBBS, Teaching Hospital, Kandy, Mawanella, Sri Lanka, Tel: 94 812 222261; E-mail: nadeeshanawarathna@yahoo.com Rec date: Oct 12 2014; Acc date: Dec 22 2014; Pub date: Jan 7 2015 Copyright: © 2015 Nawarathna NJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract 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 metastasis 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. Keywords: Follicular carcinoma; Occult thyroid carcinoma; Thoracic wall metastasis Introduction Manifestation of secondary deposits from a silent thyroid cancer is one presentation of the condition defined as occult thyroid carcinoma [1]. Approximately 25% of metastatic [2] spread from differentiated thyroid cancer (DTC) is to bone. Secondary deposit from occult thyroid cancer is rare [3] and presents a challenge to the clinician in its diagnosis. The presence of distant metastasis is reported todecrease 10year survival rate by 50% [4]. In this paper we present a middle aged male who presented with a thoracic wall mass suggestive of a soft tissue tumor. Histological analysis revealed a metastatic deposit of an occult follicular thyroid cancer. Case History A 67 year old male, presented with a lump on the left side of his chest for duration of 8 months. Initial gradual enlargement was noted with rapid enlargement over the preceding two months associated with intermittent pain. He was a known diabetic on oral hypoglycaemics. Clinical examination revealed a painless mass of 10 cm x 15 cm on the left side posterolateral chest. Further examination suggested attachment to the thoracic wall (Figure 1). Regional lymphadenopathy was not present and organ system evaluation was unremarkable. Figure 1: Thoracic Wall Metastasis Contrast enhanced computerized tomography scan revealed a mixed density mass (cystic and solid areas) within the chest wall Nawarathna et al., Thyroid Disorders Ther 2015, 4:1 DOI: 10.4172/2167-7948.1000168 Case report Open Access Thyroid Disorders Ther ISSN:2167-7948 JTDT, an open access journ Volume 4 • Issue 1 • 1000168 Journal of Thyroid Disorders & Therapy J o u r n a l o f T h y r o i d D i s o r d e r s & T h e r a p y ISSN: 2167-7948