Papillary thyroid carcinoma metastatic to skin may herald aggressive disease

To describe an unusual case of papillary thyroid carcinoma presenting as a skin lesion on the nose.

We describe the clinical, pathologic, and immunohistochemistry findings of the patient and briefly review the relevant literature.

An asymptomatic 73-year-old man noted a skin lesion on his nose, which when biopsied, revealed histopathologic characteristics consistent with papillary thyroid cancer and was immunohistochemistry positive for thyroid transcription factor-1 and thyroglobulin, also consistent with a neoplasm of thyroid origin. Subsequent physical examination showed a large left thyroid mass, and further workup demonstrated invasion of the trachea and surrounding musculature. In addition, metastases to the sternum, spine, lungs, and liver were noted. Fine-needle aspiration biopsy performed on the thyroid mass confirmed papillary thyroid carcinoma. Although there was evidence of systemic metastases, total thyroidectomy was suggested to the patient to allow optimal treatment by radioactive iodine. At operation, the cancer demonstrated fixation to the trachea and musculature, as well as infiltration of the surrounding soft tissues. Only the portion of the left thyroid mass that could be mobilized was removed. Final pathologic examination confirmed papillary thyroid carcinoma. Cutaneous metastases of thyroid carcinoma are infrequent, and, as the presenting feature of thyroid carcinoma, are even more rare. This case is noteworthy because a skin lesion was the presenting feature of thyroid carcinoma and histopathologic findings together with immunophenotyping provided the initial diagnosis.

In this patient, as in most published cases, the cutaneous metastasis was shown to occur in the setting of extensive metastases. This case also demonstrates that papillary thyroid carcinoma in men older than age 50 years can behave very aggressively.