A case of skin metastasis from papillary thyroid cancer after 30 years of thyroidectomy
A 70-years-old female presented to a clinic with a complaint of a painful and itchy lump on her scalp and medial aspect of the right arm. She had these symptoms for more than 8 months. Moreover, 30 years before her visit, she had a history of total thyroidectomy for papillary thyroid cancer. However, there was no associated history of smoking or family history of thyroid cancer.
Examination and Investigations:
Examination revealed a subcutaneous nodule on the scalp which was hard, erythematous, and tender. It measured about 1 × 1 cm. Whereas, the nodule on the medial right arm was about 1.5 x 1.5 cm. Moreover, it was non-tender and mobile. The nodule was associated with erythema and encrusting. The doctors saw no other significant findings.
For further evaluation, the doctors performed a punch biopsy of the nodule because they were highly suspicious of skin metastasis. The biopsy revealed a fibrovascular core with papillary tumour cells. In addition, the tumor cells were positive for thyroid transcription factor-1 and thyroglobulin, confirming the diagnosis of cutaneous metastasis.
Papillary Thyroid Cancer: Radioactive Iodine Resistant
The workup for staging was performed immediately after the diagnosis. The 131-iodine whole-body scan revealed the iodine-resistant disease. Moreover, a computed tomography scan in addition to positron emission tomography showed metastasis of the bone and lungs.
The doctors treated the patient with low-dose sorafenib of 400 mg per day. However, the disease became more severe instead of improving. Therefore, the doctors began palliative care. However, she could not survive the disease and died 6 months after a diagnosis of skin metastasis.