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CASE REPORT
Year : 2016  |  Volume : 13  |  Issue : 1  |  Page : 36-39

Unusual presentation of occult follicular carcinoma of thyroid: As thoracic wall lump


1 Registrar in Surgery, Teaching Hospital, Kandy, Sri Lanka
2 Senior Registrar in Surgery, Teaching Hospital, Kandy, Sri Lanka
3 Consultant General Surgeon, Teaching Hospital, Kandy, Sri Lanka

Correspondence Address:
Nadeesha J Nawarathna
Registrar in Surgery, Teaching Hospital - Kandy
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.157928

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Occult thyroid carcinoma presenting with clinically apparent metastasis is rare and is a diagnostic challenge. Here we report a 68-year-old male who presented with a left side chest wall mass of one year duration. The mass showed rapid enlargement at the latter end of its course, following an initial asymptomatic period. Imaging studies showed a soft tissue mass eroding into several ribs. Wide local excision with primary reconstruction was performed. Histological studies and immune staining revealed metastasis from a follicular thyroid carcinoma. Total thyroidectomy followed, confirming the diagnosis. Post-operatively radio isotope ablation (I131) was done. A suppression dose of thyroxin was continued with regular thyroglobulin assays. Painful bone metastasis responded well to analgesics, bisphosphonates and external beam radiotherapy. Follicular carcinoma comprise 10–15% of thyroid malignancies. Localized thyroid carcinoma has a very good prognosis, 10 year survival rates reducing by 50% with metastatic disease. Commonly thyroid cancer presents as detectable thyroid nodules, 25% having metastasis. In contrast metastatic manifestations are reported in less than 5% of occult thyroid cancers.


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