An expected culprit in an improbable location: Metastatic breast cancer found in a thyroid nodule
Location
Culp Center Ballroom
Start Date
4-25-2023 9:00 AM
End Date
4-25-2023 11:00 AM
Poster Number
88
Faculty Sponsor’s Department
Other - please list
Medical Oncology
Name of Project's Faculty Sponsor
Kanishka Chakraborty
Competition Type
Competitive
Type
Poster Presentation
Project's Category
Cancer or Carcinogenesis
Abstract or Artist's Statement
Considered the most common malignancy in women in the United States and second leading cause of cancer death among women, breast cancer has had a shift in paradigm of treatment within the recent years and undertaken significant research for new targeted treatment with a more molecular driven approach which has led to increased survival rates amongst women diagnosed with early stage breast cancer. The risk of recurrence however persists overtime, particularly in hormone receptor positive breast cancer, which has demonstrated recurrence rates as late as 30 years after initial diagnosis. This leads to a higher need for increased awareness of late recurrence rates in early stage breast cancer patients and reminds us to be wary of any new findings that in other patients may be considered as benign.
We present a case of a 67-year-old female with remote history of locally advanced hormone positive breast cancer in 2005 who underwent mastectomy with lymph node dissection followed by adjuvant chemotherapy, radiation, and endocrine therapy for at least 8 years who presented to our clinic 18 years after initial diagnosis with an enlarging nodule in her neck. Patient underwent a thyroid ultrasound which showed a suspicious thyroid nodule concerning for malignancy classified as TIRADS-5. Further systemic imaging via PET-Scan demonstrated surrounding cervical lymphadenopathy adjacent to the thyroid nodule with increased fluorodeoxyglucose (FDG) avidity. She proceeded to undergo a thyroid fine needle biopsy, which was suspicious for malignancy. A repeat thyroid fine needle biopsy was obtained this time confirming metastatic breast cancer. Considering the rarity of such event, we proceeded with further testing of biopsied tissue via cancer type ID, which confirmed presence of metastatic breast cancer in the thyroid. Patient was informed of now metastatic breast cancer diagnosis with plans to start Faslodex and Ibrance. Unfortunately, she developed rapid disease progression with hospitalization due to a recurrent malignant pericardial effusion suggestive of visceral crisis requiring initiation on palliative chemotherapy with Carboplatin and Gemcitabine. Patient has been tolerating systemic chemotherapy well with interval clinical decrease of more than 50% in size of her surrounding cervical lymphadenopathy and resolution of pericardial effusion.
The incidence of thyroid metastatic disease from breast cancer is very rare accounting for only 0.2% of fine needle biopsy aspirations. The most common sites of breast cancer metastasis include lung, bone, liver, and brain. On the other hand, the most common primary malignancies that can cause metastasis to the thyroid are kidney, gastrointestinal tract, and lung. However, as of 2018 around 42 cases of metastatic breast cancer found in the thyroid had been reported and it was also noted that metastatic thyroid involvement of breast cancer could be associated with a poor prognosis. This case represents the importance of being aware of the risk of late recurrence in hormone positive breast cancers, which in turn should result in a lower threshold for thorough workup of common clinical findings in these patients.
An expected culprit in an improbable location: Metastatic breast cancer found in a thyroid nodule
Culp Center Ballroom
Considered the most common malignancy in women in the United States and second leading cause of cancer death among women, breast cancer has had a shift in paradigm of treatment within the recent years and undertaken significant research for new targeted treatment with a more molecular driven approach which has led to increased survival rates amongst women diagnosed with early stage breast cancer. The risk of recurrence however persists overtime, particularly in hormone receptor positive breast cancer, which has demonstrated recurrence rates as late as 30 years after initial diagnosis. This leads to a higher need for increased awareness of late recurrence rates in early stage breast cancer patients and reminds us to be wary of any new findings that in other patients may be considered as benign.
We present a case of a 67-year-old female with remote history of locally advanced hormone positive breast cancer in 2005 who underwent mastectomy with lymph node dissection followed by adjuvant chemotherapy, radiation, and endocrine therapy for at least 8 years who presented to our clinic 18 years after initial diagnosis with an enlarging nodule in her neck. Patient underwent a thyroid ultrasound which showed a suspicious thyroid nodule concerning for malignancy classified as TIRADS-5. Further systemic imaging via PET-Scan demonstrated surrounding cervical lymphadenopathy adjacent to the thyroid nodule with increased fluorodeoxyglucose (FDG) avidity. She proceeded to undergo a thyroid fine needle biopsy, which was suspicious for malignancy. A repeat thyroid fine needle biopsy was obtained this time confirming metastatic breast cancer. Considering the rarity of such event, we proceeded with further testing of biopsied tissue via cancer type ID, which confirmed presence of metastatic breast cancer in the thyroid. Patient was informed of now metastatic breast cancer diagnosis with plans to start Faslodex and Ibrance. Unfortunately, she developed rapid disease progression with hospitalization due to a recurrent malignant pericardial effusion suggestive of visceral crisis requiring initiation on palliative chemotherapy with Carboplatin and Gemcitabine. Patient has been tolerating systemic chemotherapy well with interval clinical decrease of more than 50% in size of her surrounding cervical lymphadenopathy and resolution of pericardial effusion.
The incidence of thyroid metastatic disease from breast cancer is very rare accounting for only 0.2% of fine needle biopsy aspirations. The most common sites of breast cancer metastasis include lung, bone, liver, and brain. On the other hand, the most common primary malignancies that can cause metastasis to the thyroid are kidney, gastrointestinal tract, and lung. However, as of 2018 around 42 cases of metastatic breast cancer found in the thyroid had been reported and it was also noted that metastatic thyroid involvement of breast cancer could be associated with a poor prognosis. This case represents the importance of being aware of the risk of late recurrence in hormone positive breast cancers, which in turn should result in a lower threshold for thorough workup of common clinical findings in these patients.