Metastatic follicular carcinoma to the thoracic wall 3 years post thyroidectomy for colloid adenomatous goiter

Introduction

Metastasis to the sternum from Follicular Thyroid Carcinoma (FTC) is rare. Only a handful of cases can be found in literature. Delayed metastasis to the bone has been reported but in a setting of a known thyroid primary.

Case report

This is a case of a 51-year-old female, presenting with an anterior chest mass in the background of previous right thyroid lobectomy with isthmusectomy for multinodular colloid adenomatous goiter. Multiple attempts to establish tissue diagnosis were not conclusive, hence outright surgical resection was pursued. She underwent partial sternectomy to include the manubrium sterni and the costochondral junctions of the first and 2nd ribs bilaterally, frozen section and completion thyroidectomy. She also underwent segmental resection of the right 12th rib, phrenicorrhaphy, tube thoracostomy. Subsequently, radioactive iodine therapy was given as part of her definitive treatment.

Discussion

Radical chest wall excision in the form of sternectomy or rib resection together with reconstruction is not the preferred treatment of choice in prior literature for the management of metastatic thyroid carcinoma. However, recent advances in thyroid carcinoma studies have proposed this approach to decrease the burden of the disease as well as improve relapse free survival.

Conclusion

Though unconventional, surgical management for metastatic follicular thyroid carcinoma

provides a viable option to improve the patient’s quality of life. However, further research on its clinical behavior and potential targeted therapies is still needed.