Follicular thyroid carcinoma with sternal metastasis: A case report

Sternal metastasis of follicular thyroid cancer (FTC) is rare as only 15 cases have been reported in the literature in which most cases of sternal metastasis occurs form breast and lung cancer. Surgical excision of the metastatic mass provides the best option due to its curative benefit, symptomatic palliation, and better response to radioactive iodine.

Herein, we present a 77-year-old female patient with a known history of follicular thyroid carcinoma with isolated sternal metastasis treated with total thyroidectomy and en-bloc resection of the metastasis, followed by chest wall reconstruction using pectoralis major muscle flap.

Surgical excision of metastatic FTC to sternum with chest wall reconstruction was seldom reported as the treatment of choice. In most cases in the literature, mesh was used. However, in our patient mesh was not used taking into consideration the drastic consequences of wound infection and the possible need for mesh retrieval in such a dangerous area in proximity to the mediastinum. We believe that myo-adipo-facial flap is a more reasonable and safe option.

In patients with FTC, large tumors and bone metastases are factors that indicate poor prognostic factors, both of which were present in our patient. However, surgical excision provides hope for a better quality of life as it enhances subsequent Radioactive Iodine (RAI) therapy.