Metastatic Cervical Carcinoma to the Thyroid Gland: A Case Report and Review of the Literature
A 68-year-old woman was admitted to our department after complaining of a persistent cough over the course of a week, hemoptysis, and a temperature that would peak at 37.8°C (100°F) over the last two months. She had noticed a painless swelling in the region of the thyroid gland and a palpable mass in the right side of her neck. Four years ago, the patient had been diagnosed with squamous cell carcinoma of the cervix stage ΙΙΙΒ, moderately differentiated, for which she had received external beam radiotherapy to the pelvis and brachytherapy.\nUpon physical examination, an irregular, hard-fixed mass measuring 8.6 cm was felt in the right lateral region of the neck, along with a firm thyroid enlargement. Chest auscultation revealed altered breath sounds in the left lung, with rales and rhonchi. Her blood cell count and serum biochemistry were normal, and the rate of sedimentation was 65mm the first hour. The patient underwent a CT scan of the neck, thorax, abdomen, and pelvis that revealed a large irregular mass 9 cm in diameter in the right lateral region of the neck, enlargement of the thyroid gland, enlarged mediastinal and paraaortic nodes, and multiple patchy airspace infiltrates, without evidence of local recurrence. A bone scan was negative for metastases. Fiberoptic bronchoscopy revealed edematous and erythematous mucosa of the upper bronchus of the right lower lobe and erythematous edematous mucosa with probable subserosa infiltration of the lingual bronchus. Sputum cytology after bronchoscopy washing and brushing was positive for undifferentiated carcinoma. Since the cytology report could not establish a definite diagnosis, a biopsy of the thyroid gland was performed, which showed non-keratinizing squamous cell carcinoma compatible with primary squamous cell carcinoma of the cervix. The pathologist also reviewed slides of the cervical biopsy from four years previous and confirmed that the thyroid tumor was histologically identical to the initially documented cervical carcinoma.\nThe patient received six cycles of systematic chemotherapy with cisplatin and gemcitabine, with partial response. Subsequently, she received radiation therapy to the right side of the neck and the thyroid, with further decrease of the lymph nodes and thyroid mass. Five months after the completion of radiotherapy, the patient developed progressive disease and succumbed four months later. The overall survival after diagnosis of the thyroid metastasis was 16 months.