Concurrent Thyroid and Lung Nodules: Unveiling Rare Pathways in Malignancy

Document Type

Conference Proceeding

Publication Date

10-25-2024

Publication Title

Thyroid

Abstract

Introduction: Thyroid cancer (TC) is the most common endocrine malignancy. Despite its frequency, distant metastases are seen in only 1% to 4% of patients. However, such metastatic events often carry a grim prognosis, becoming the primary driver of TC-related fatalities. Conversely, metastasis to the thyroid gland is rare, with breast, renal cell and lung being the most common primary sites. While instances of patients having two distinct primary malignancies exist, most cases involving multiple organs originate from a single primary source. This case series highlights patients with co-existing lung and thyroid nodules each exhibiting unique outcomes. Case series: We present three cases involving concurrent thyroid and lung masses. The first case involved bilateral lung nodules seen on CT ordered for evaluation of cough. A thyroid nodule was detected concurrently and an FNA showed atypical cells of undetermined origin. Further molecular testing showed a TERT mutation and concurrently a lung biopsy showed metastatic melanoma with an identical TERT mutation. The second case involved incidentally discovered lung nodules with lymphadenopathy in a non-smoker. Biopsy revealed adenocarcinoma with BRAF V 600 E mutation. PET-CT showed cervical lymphadenopathy and further evaluation revealed multiple thyroid nodules in the US. FNA biopsy of thyroid nodules showed papillary TC without BRAF V 600 E mutation. The third case had thyroid nodules and was diagnosed with papillary thyroid cancer after FNA biopsy. Her CT chest noted multiple bilateral pulmonary nodules with the largest in the left lower lobe. FNA of lung nodules confirmed metastatic PTC. Conclusions: A thorough review of existing literature revealed no consensus regarding the incidence of synchronous lung and thyroid nodules. Instances of TC metastases and a separate primary cancer spreading to the thyroid are both rare phenomena. Moreover, the presence of two distinct primary malignancies is uncommon. Our case series underscores the importance of obtaining proper tissue samples of both lung and thyroid masses identified concurrently to facilitate accurate diagnosis and treatment.

Volume

34

First Page

A25

Last Page

A26

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