Fracture of the Humeral Bone as the First Clinical Presentation of Metastatic Papillary Thyroid Carcinoma in Ibadan

Main Article Content

Mustapha Akanji Ajani
Babatope Lanre Awosusi
Ebenezer O. Fatunla
Omolade O. Adegoke
Ayodeji A. Salami

Abstract

Papillary thyroid carcinoma is the commonest type of thyroid cancer representing 75 to 85 per cent of all thyroid cancer cases. It is often well-differentiated, slow-growing, and localized, although it can metastasize. This is a case of a 49-year-old male who presented with a pathological fracture of the left humerus. A bone biopsy was done at the surgery which had a histological diagnosis of metastatic thyroid carcinoma. A total thyroidectomy was subsequently done and was histologically reported as a follicular variant of papillary thyroid carcinoma. The patient was clinically stable post-thyroidectomy and was discharged home on the 10th postoperative day and he is currently being followed-up in the surgical outpatient clinic. Pathological fracture as the initial clinical presentation is an unusual manifestation of metastatic thyroid carcinoma; therefore a high index of suspicion is needed to make this diagnosis. In any patient presenting with a pathologic fracture, the possibility of metastatic carcinoma from the thyroid gland should always be considered.

Keywords:
Papillary thyroid carcinoma, metastasis, humerus, fracture

Article Details

How to Cite
Ajani, M., Awosusi, B., Fatunla, E. O., Adegoke, O., & Salami, A. A. (2019). Fracture of the Humeral Bone as the First Clinical Presentation of Metastatic Papillary Thyroid Carcinoma in Ibadan. Asian Journal of Medicine and Health, 16(4), 1-7. https://doi.org/10.9734/ajmah/2019/v16i430149
Section
Case Study

References

Mitchell Richard Sheppard, Kumar Vinay Abbas, Abul K, Fausto Nelson. Robbins Basic Pathology. Philadelphia: Saunders. 8th Edition; 2007.
ISBN 978-1-4160-2973-1

Dinets A, Hulchiy M, Sofiadis A, Ghaderi M, Höög A, Larsson C, et al. Clinical, genetic and immunohistochemical characterization of 70 ukrainian adult Cases with Post-Chornobyl Papillary Thyroid Carcinoma. Eur J Endocrinol. 2012;166:1049–60.

Somasundar S. Papillary thyroid carcinoma.
Available:https://emedicine.medscape.com/article/282276-overview#a6
(Accessed on Jan 7, 2019)

Subha ST, Bakri MA, Salleh H. Doi M, Nordin AJ. Papillary thyroid carcinoma presenting as a cystic neck lesion: Case series. Iranian Journal of Otorhinolaryngology. 2018;30(96):49.

Der EM. Follicular thyroid carcinoma in a country of endemic iodine deficiency (1994–2013). Journal of Thyroid Research; 2018.

Shi X, Liu R, Basolo F, Giannini R, Shen X, Teng D, et al. Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants. J Clin Endocrinology. 2016;101:264-274.

Seethala RR, Baloch ZW, Barletta JA, Khanafshar E, Mete O, Sadow PM, Thompson LD. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a review for pathologists. Modern Pathology. 2018;31(1):39.

Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;174:474-476

Lin JD, Lin SF, Chen ST, Hsueh C, Li CL, Chao TC. Long-term follow-up of papillary and follicular thyroid carcinomas with bone metastasis. Plos One. 2017;12:e0173354. Available:https://doi.org/10.1371/journal.pone.0173354

Untch BR, Palmer FL, Ganly I, Patel SG, Michael Tuttle R, Shah JP, et al. Oncologic outcomes after completion thyroidectomy for patients with well-differentiated thyroid carcinoma. Am Surg Oncol. 2014; 21:1374–1378.

Satish K. Tickoo, Anastassios G. Pittas, Michael Adler, Melissa Fazzari, Steven M. Larson, Richard J. Robbins, Juan Rosai. Bone metastases from thyroid carcinoma. Archives of Pathology & Laboratory Medicine: 2000;124:1440-1447.

LiVolsi. Papillary thyroid carcinoma: An update. Modern pathology. 2001;24:S1-S9.

Heitz P, Moser H, Staub JJ. Thyroid cancer: A study of 573 thyroid tumors and 161 autopsy cases observed over a thirty-year period. Cancer.1976;37:2329–2337.

Ruegemer JJ, Hay ID, Bergstralh EJ, Ryan JJ, Offord KP, Gorman CA. Distant metastases in differentiated thyroid carcinoma: A multivariate analysis of prognostic variables. J Clin Endocrinol Metab. Seda Sezen Göktaş. 1988;67:501–508.

Bone Metastasis in Thyroid Cancer: A Literature Review. Otolaryngol Open Access J. 2018;3(2):000169.

Hsiao FC, Chen CL, Lin TY, Yi-Jen Hung, Ming-Fang Cheng, et al. Metastatic spinal cord compression as initial presentation of occult follicular thyroid carcinoma. J Med Sci. 2008;28(2):89-93.

Ramadan S, Ugas MA, Berwick RJ, Manisha Notay, Hyongyu Cho, et al. Spinal metastasis in thyroid cancer. Head Neck Oncol 2012;4:39.

Ganeshan D, Paulson E, Duran C, Cabanillas M, Busaidy N, Charnsangavej C. Current Update on medullary thyroid carcinoma. AJR. 2013;201(6):867-876.

Muresan MM, Olivier P, Leclère J, Sirveaux F, Brunaud L, Klein M, et al. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer. 2008;15:37–49.

Pittas AG, Adler M, Fazzari M, Tickoo S, Rosai J, Larson SM, et al. Bone metastases from thyroid carcinoma: Clinical characteristics and prognostic variables in one hundred forty-six patients. Thyroid. 2000;10:261–268.

Gonzalez-García A, Sifuentes-Giraldo WA and Pena JLP. Pathologic Fracture of Humerus as the Initial Manifestation of Metastatic Thyroid carcinoma. SM Radiol J. 2015;1:1008.