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Occult Papillary Carcinoma Thyroid with Solitary Appendicular Bone Metastasis in Proximal Humerus - A Case Report
Prabodh Kantiwal1, Vimal Prakash1, Sandeep Kumar Yadav1
1Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Introduction:
An occult presentation of primary thyroid malignancy refers to a clinically silent primary tumor that initially manifests through metastasis or secondary paraneoplastic phenomena. Papillary carcinoma is a well-recognized thyroid malignancy associated with this pattern of presentation, but bone metastases are uncommon in occult papillary thyroid carcinoma (OPTC), with reported cases typically involving the axial skeleton.
Case Report:
A woman in her 70s presented with swelling and pain in her right arm. Examination revealed an oval swelling on the proximal humerus. Radiographs and magnetic resonance images suggested a lytic lesion in the proximal humerus. Upon metastatic workup, biopsy, and immunohistochemistry, the diagnosis turned out to be metastasis from occult papillary thyroid cancer.
Conclusion:
Bone metastases are uncommon in OPTC, with reported cases typically involving the axial skeleton. Metastasis to the appendicular skeleton as the initial presentation is exceptionally rare.
