Abstract

Case Report

Uncommon first diagnosis of metastatic papillary thyroid carcinoma with “signet-ring” cells morphology through pericardial effusion

Angeliki Cheva, Sokratis Tsagkaropoulos*, Panagiotis Pepis, Antonia Syrnioti and Christoforos Foroulis

Published: 20 January, 2022 | Volume 6 - Issue 1 | Pages: 005-008

Malignant pericardial effusion is a usual and crucial exacerbation in malignancies. In some cases, pericardial effusion may be the first manifestation of the disease. Neoplastic pericarditis is extremely rare in thyroid cancer. Hereby, we describe the case of a 54-year-old man submitted to the hospital for chest pain and dyspnea. Clinical and radiological examinations were suggestive of pericardial effusion and mediastinal lymphadenopathy. The patient underwent pericardial drainage and surgical biopsy of a paratracheal lymph node. Pericardial biopsies were also taken. Histology study was compatible with metastatic papillary thyroid carcinoma with “signet-ring” cell morphology. Extended study of thyroid gland and function was performed and he was referred to oncologists for further treatment. 
Clinical presentation and histology are discussed emphasizing the rare correlation between pericardial pathology and metastatic thyroid carcinomas as the first diagnosis. Histopathologic findings of “signet-ring” cell morphology are very challenging for a differential diagnosis between thyroid carcinoma and other metastatic adenocarcinomas.

Read Full Article HTML DOI: 10.29328/journal.acr.1001057 Cite this Article Read Full Article PDF

Keywords:

Papillary thyroid carcinoma; Pericardial effusion; Metastatic adenocarcinoma; Signet ring cell thyroid carcinoma; Lymphadenopathy

References

  1. Romero-Rojas AE, Diaz-Perez JA, Mastrodimos M, Chinchilla SI. Follicular thyroid carcinoma with signet ring cell morphology: fine-needle aspiration cytology, histopathology, and immunohistochemistry. Endocr Pathol. 2013; 24: 239-245. PubMed: https://pubmed.ncbi.nlm.nih.gov/24068558/
  2. Burazor I, Imazio M, Markel G, Adler Y. Malignant Pericardial Effusion. Cardiology. 2013; 124: 224-232. PubMed: https://pubmed.ncbi.nlm.nih.gov/23571453/
  3. Chiewvit S, Pusuwan P, Chiewvit P, Pleehachinda R, Attanatho V, et al. Metastatic follicular carcinoma of thyroid to pericardium. J Med Assoc Thai. 1998; 81: 799-802. PubMed: https://pubmed.ncbi.nlm.nih.gov/9803073/
  4. Kovacs CS, Nguyen GK, Mullen JC, Crockford PM. Cardiac tamponade as the initial presentation of papillary thyroid carcinoma. Can J Cardiol. 1994; 10: 279-281. PubMed: https://pubmed.ncbi.nlm.nih.gov/8143231/
  5. Tsoukalas N, Kostakis ID, Demiri S, Koumakis G, Barbounis V, et al. Neoplastic pericarditis as the initial manifestation of a papillary thyroid carcinoma. Ups J Med Sci. 2013; 118: 196-198. PubMed: https://pubmed.ncbi.nlm.nih.gov/23697667/
  6. Besic N, Gazic B. Sites of metastases of anaplastic thyroid carcinoma: autopsy findings in 45 cases from a single institution. Thyroid. 2013; 23: 709-713. PubMed: https://pubmed.ncbi.nlm.nih.gov/23148580/
  7. Farhat NA, Onenerk AM, Krane JF, Dias-Santagata D, Sadow PM, et al. Primary Benign and Malignant Thyroid Neoplasms with Signet Ring Cells: Cytologic, Histologic, and Molecular Features. Am J Clin Pathol. 2017; 148: 251-258. PubMed: https://pubmed.ncbi.nlm.nih.gov/28821194/
  8. Chiofalo MG, Losito NS, Fulciniti F, Setola SV, Tommaselli A, et al. Axillary node metastasis from differentiated thyroid carcinoma with Hürthle and signet ring cell differentiation. A case of disseminated thyroid cancer with peculiar histologic findings. BMC Cancer. 2012; 12: 55. PubMed: https://pubmed.ncbi.nlm.nih.gov/22304797/
  9. Juhlin CC, Bränström R, Shabo I, Höög A. Clear cell variant of a follicular thyroid tumor with uncertain malignant potential: a case report. Int J Surg Pathol. 2019; 27: 290-293. PubMed: https://pubmed.ncbi.nlm.nih.gov/30370813/
  10. Pagni F, Ronchi S, Di Bella C, Serra G, Costantini M, et al. Signet-ring cell differentiation in FNA cytology of a primitive thyroid carcinoma. Cytopathology. 2013; 24: 274-275. PubMed: https://pubmed.ncbi.nlm.nih.gov/22409226/
  11. Ma C, Lowenthal BM, Pai RK. SATB2 Is Superior to CDX2 in Distinguishing Signet Ring Cell Carcinoma of the Upper Gastrointestinal Tract and Lower Gastrointestinal Tract. Am J Surg Pathol. 2018; 42: 1715-1722. PubMed: https://pubmed.ncbi.nlm.nih.gov/30212392/
  12. Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M. Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. Endocr Pathol. 2020; 31: 197-217. PubMed: https://pubmed.ncbi.nlm.nih.gov/32632840/

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