Follicular thyroid carcinoma presenting as axial skeletal metastases

Sreedharan S, Pang CE, Chan GSW, Soo KC, Lim DTH
Correspondence: Dr Sreedharan S, sreedharan.sechachalam@singhealth.com.sg

ABSTRACT
Introduction Common modes of presentation of follicular thyroid carcinoma include a solitary thyroid nodule and cervical lymphadenopathy. We report four patients who presented with axial skeletal metastases rather than the usual neck lumps. 
Methods A review of a database of 389 cases of thyroid cancer, managed by our department from 1990 to 2003, was perfomed. Based on each patient's presenting clinical feature, patients for the case series were selected.
Results Four of the 389 patients presented with axial skeletal metastases - three were in the scalp while the fourth was in the sacral region. The histology of all four cases was that of follicular thyroid carcinoma. Despite widespread metastases at presentation, the overall survival rates of these patients remained relatively good.
Conclusion Patients presenting with lesions suspicious of secondary malignancy in the axial skeleton should be clinically evaluated for thyroid cancer. This is especially important if the patient belongs to a high risk age group and has highly vascular lesions.

Keywords: axial skeletal metastasis, follicular thyroid carcinoma, papillary thyroid carcinoma, sacral metastasis, scalp metastasis, thyroid carcinoma
Singapore Med J 2007; 48(7): 640–644