Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management
Objective: Distant metastases from papillary thyroid carcinoma (PTC) are relatively rare and may be associated with a poor prognosis. The adrenal gland is a highly unusual site of metastasis in the natural course of PTC. Herein, we describe a case of an incidentally detected metastatic solid variant...
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Elsevier
2022-05-01
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| Series: | AACE Clinical Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060522000025 |
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| author | John D. Karalis, MD Liwei Jia, MD, PhD Natia Murvelashvili, MD Amy Vora, MD Alex Tessnow, MD Alan P.B. Dackiw, MD, PhD, MBA |
| author_facet | John D. Karalis, MD Liwei Jia, MD, PhD Natia Murvelashvili, MD Amy Vora, MD Alex Tessnow, MD Alan P.B. Dackiw, MD, PhD, MBA |
| author_sort | John D. Karalis, MD |
| collection | DOAJ |
| description | Objective: Distant metastases from papillary thyroid carcinoma (PTC) are relatively rare and may be associated with a poor prognosis. The adrenal gland is a highly unusual site of metastasis in the natural course of PTC. Herein, we describe a case of an incidentally detected metastatic solid variant of PTC in the adrenal gland of an asymptomatic patient as the initial presentation. Case Report: A 67-year-old male patient was evaluated for a 4.7-cm adrenal incidentaloma discovered during a workup for nephrolithiasis. Biochemical evaluation revealed a nonfunctioning adrenal mass. The patient underwent adrenalectomy, which revealed metastatic PTC. A subsequent thyroid ultrasound revealed an isthmic nodule. Fine needle aspiration of the nodule was cytologically suspicious for a follicular neoplasm, and gene expression analysis revealed an HRAS c.182A>G sequence variation. The patient subsequently underwent total thyroidectomy, which revealed a 1.2-cm solid variant of PTC in the thyroid isthmus. Postoperatively, the patient underwent radioactive iodine ablation. Discussion: Our case illustrates an exceedingly rare and challenging situation—a metastatic solid variant of PTC in the adrenal gland of a patient with no prior history of PTC. When confronted with a PTC in the adrenal gland in the absence of a previously identified primary tumor, our experience suggests that the next step in management should be total thyroidectomy followed by radioactive iodine ablation. Conclusion: A solid variant of PTC is a rare cause of an incidentally detected adrenal lesion. Multidisciplinary care team coordination is essential for accurate diagnosis and treatment plan formulation. |
| first_indexed | 2024-12-12T04:20:33Z |
| format | Article |
| id | doaj.art-e483a849c5fd4ca7b208406dd9cd12d4 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-12T04:20:33Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-e483a849c5fd4ca7b208406dd9cd12d42022-12-22T00:38:20ZengElsevierAACE Clinical Case Reports2376-06052022-05-0183131134Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical ManagementJohn D. Karalis, MD0Liwei Jia, MD, PhD1Natia Murvelashvili, MD2Amy Vora, MD3Alex Tessnow, MD4Alan P.B. Dackiw, MD, PhD, MBA5Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Address correspondence to Dr John D. Karalis, Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390.Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TexasDivision of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TexasDivision of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TexasDivision of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TexasDivision of General Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TexasObjective: Distant metastases from papillary thyroid carcinoma (PTC) are relatively rare and may be associated with a poor prognosis. The adrenal gland is a highly unusual site of metastasis in the natural course of PTC. Herein, we describe a case of an incidentally detected metastatic solid variant of PTC in the adrenal gland of an asymptomatic patient as the initial presentation. Case Report: A 67-year-old male patient was evaluated for a 4.7-cm adrenal incidentaloma discovered during a workup for nephrolithiasis. Biochemical evaluation revealed a nonfunctioning adrenal mass. The patient underwent adrenalectomy, which revealed metastatic PTC. A subsequent thyroid ultrasound revealed an isthmic nodule. Fine needle aspiration of the nodule was cytologically suspicious for a follicular neoplasm, and gene expression analysis revealed an HRAS c.182A>G sequence variation. The patient subsequently underwent total thyroidectomy, which revealed a 1.2-cm solid variant of PTC in the thyroid isthmus. Postoperatively, the patient underwent radioactive iodine ablation. Discussion: Our case illustrates an exceedingly rare and challenging situation—a metastatic solid variant of PTC in the adrenal gland of a patient with no prior history of PTC. When confronted with a PTC in the adrenal gland in the absence of a previously identified primary tumor, our experience suggests that the next step in management should be total thyroidectomy followed by radioactive iodine ablation. Conclusion: A solid variant of PTC is a rare cause of an incidentally detected adrenal lesion. Multidisciplinary care team coordination is essential for accurate diagnosis and treatment plan formulation.http://www.sciencedirect.com/science/article/pii/S2376060522000025adrenal incidentalomapapillary thyroid cancersolid variant of papillary thyroid cancerpapillary thyroid cancer metastatic to the adrenal gland |
| spellingShingle | John D. Karalis, MD Liwei Jia, MD, PhD Natia Murvelashvili, MD Amy Vora, MD Alex Tessnow, MD Alan P.B. Dackiw, MD, PhD, MBA Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management AACE Clinical Case Reports adrenal incidentaloma papillary thyroid cancer solid variant of papillary thyroid cancer papillary thyroid cancer metastatic to the adrenal gland |
| title | Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management |
| title_full | Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management |
| title_fullStr | Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management |
| title_full_unstemmed | Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management |
| title_short | Incidental Solitary Adrenal Metastasis as the Initial Manifestation of a Solid Variant of Papillary Thyroid Carcinoma, With Emphasis on Pathologic Diagnosis and Clinical Management |
| title_sort | incidental solitary adrenal metastasis as the initial manifestation of a solid variant of papillary thyroid carcinoma with emphasis on pathologic diagnosis and clinical management |
| topic | adrenal incidentaloma papillary thyroid cancer solid variant of papillary thyroid cancer papillary thyroid cancer metastatic to the adrenal gland |
| url | http://www.sciencedirect.com/science/article/pii/S2376060522000025 |
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