Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension
ABSTRACT: Objective: In contrast to well-differentiated and anaplastic thyroid carcinomas, metastasis patterns are not well-known for poorly differentiated thyroid carcinoma (PDTC). We report an unusual case of PDTC initially presenting as unilateral exophthalmos.Methods: Clinical, laboratory, imagi...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-01-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520302017 |
| _version_ | 1818953989313527808 |
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| author | Jill B. Feffer, MD Gianina L. Usera, MD Rifka C. Schulman, MD |
| author_facet | Jill B. Feffer, MD Gianina L. Usera, MD Rifka C. Schulman, MD |
| author_sort | Jill B. Feffer, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective: In contrast to well-differentiated and anaplastic thyroid carcinomas, metastasis patterns are not well-known for poorly differentiated thyroid carcinoma (PDTC). We report an unusual case of PDTC initially presenting as unilateral exophthalmos.Methods: Clinical, laboratory, imaging, and pathology data are presented.Results: A 55-year-old woman without significant medical history presented to an outside hospital complaining of a “bulging” left eye for several weeks. Computerized tomography–guided excisional biopsy of a left orbital mass revealed poorly differentiated insular thyroid carcinoma (positive for cytokeratins, thyroid transcription factor-1, and thyroglobulin; negative for monoclonal carcinoembryonic antigen, S100, chromogranin, and synaptophysin) with a Ki-67 index of 5 to 10%. In the midst of outpatient management, including treatment with dexamethasone, she presented to our tertiary center in diabetic ketoacidosis. Physical examination demonstrated unilateral left-sided exophthalmos and an unremarkable thyroid gland. Brain magnetic resonance imaging confirmed an exophytic mass centered on the wing of the left sphenoid bone with intracranial and intra-orbital extension. Thyroid ultrasound demonstrated a dominant hypoechoic nodule in the right lobe with possible punctate microcalcifications; fine needle aspiration confirmed PDTC. Neurosurgery was recommended but the patient declined. Following outpatient radiation to the left orbit, she was readmitted for dyspnea on exertion due to new bilateral pulmonary emboli. The patient was no longer a candidate for thyroidectomy and was referred for home hospice services.Conclusion: PDTC is a relatively new entity with poorly defined patterns of metastasis. We present the first reported case of PDTC with metastasis to the orbit initially presenting as unilateral exophthalmos.Abbreviations: FTC = follicular thyroid carcinoma; PDTC = poorly differentiated thyroid carcinoma; WBI = whole-body iodine |
| first_indexed | 2024-12-20T10:15:02Z |
| format | Article |
| id | doaj.art-5be5176016834170b960ca4949e88aa4 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-20T10:15:02Z |
| publishDate | 2017-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-5be5176016834170b960ca4949e88aa42022-12-21T19:44:06ZengElsevierAACE Clinical Case Reports2376-06052017-01-0132e89e92Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital ExtensionJill B. Feffer, MD0Gianina L. Usera, MD1Rifka C. Schulman, MD2From the 1Division of Endocrinology, Diabetes and Metabolism, Mount Sinai St. Luke's West, New York, New York; Address correspondence to Dr. Jill B. Feffer, Division of Endocrinology, Diabetes and Metabolism, Mount Sinai St. Luke's, 1111 Amsterdam Avenue, Babcock 10 Room 1020, New York, NY 10025. E-mail:Division of Endocrinology and Metabolism, Department of Medicine, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York.Division of Endocrinology and Metabolism, Department of Medicine, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York.ABSTRACT: Objective: In contrast to well-differentiated and anaplastic thyroid carcinomas, metastasis patterns are not well-known for poorly differentiated thyroid carcinoma (PDTC). We report an unusual case of PDTC initially presenting as unilateral exophthalmos.Methods: Clinical, laboratory, imaging, and pathology data are presented.Results: A 55-year-old woman without significant medical history presented to an outside hospital complaining of a “bulging” left eye for several weeks. Computerized tomography–guided excisional biopsy of a left orbital mass revealed poorly differentiated insular thyroid carcinoma (positive for cytokeratins, thyroid transcription factor-1, and thyroglobulin; negative for monoclonal carcinoembryonic antigen, S100, chromogranin, and synaptophysin) with a Ki-67 index of 5 to 10%. In the midst of outpatient management, including treatment with dexamethasone, she presented to our tertiary center in diabetic ketoacidosis. Physical examination demonstrated unilateral left-sided exophthalmos and an unremarkable thyroid gland. Brain magnetic resonance imaging confirmed an exophytic mass centered on the wing of the left sphenoid bone with intracranial and intra-orbital extension. Thyroid ultrasound demonstrated a dominant hypoechoic nodule in the right lobe with possible punctate microcalcifications; fine needle aspiration confirmed PDTC. Neurosurgery was recommended but the patient declined. Following outpatient radiation to the left orbit, she was readmitted for dyspnea on exertion due to new bilateral pulmonary emboli. The patient was no longer a candidate for thyroidectomy and was referred for home hospice services.Conclusion: PDTC is a relatively new entity with poorly defined patterns of metastasis. We present the first reported case of PDTC with metastasis to the orbit initially presenting as unilateral exophthalmos.Abbreviations: FTC = follicular thyroid carcinoma; PDTC = poorly differentiated thyroid carcinoma; WBI = whole-body iodinehttp://www.sciencedirect.com/science/article/pii/S2376060520302017 |
| spellingShingle | Jill B. Feffer, MD Gianina L. Usera, MD Rifka C. Schulman, MD Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension AACE Clinical Case Reports |
| title | Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension |
| title_full | Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension |
| title_fullStr | Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension |
| title_full_unstemmed | Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension |
| title_short | Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension |
| title_sort | unilateral exophthalmos due to metastasis of poorly differentiated thyroid carcinoma to the left sphenoid wing with intra orbital extension |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520302017 |
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