Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.1106
Peer-review started: July 24, 2021
First decision: October 22, 2021
Revised: October 28, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
Metastasis to the thyroid gland (TM) from primary breast cancer is uncommon and usually presents as thyroid nodules; however, diffuse goiter without thyroid nodules is the first sign of TM in rare cases. Skip metastases (SMs) to the lymph nodes in breast cancer, defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases, have been reported in the contralateral cervical area of the primary tumor site in rare cases.
A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection. No malignancy of the left breast or axillary or distant metastases were identified preoperatively. However, enlarged left cervical lymph nodes were detected 36 mo after surgery, and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery. Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid, which were both revealed to contain metastases from the primary breast cancer. Additionally, the immunostaining profiles changed in the process of metastases. The patient was discharged with the NP (vinorelbine and cisplatin) regimen for subsequent treatment, and stable disease was determined when the curative effect was evaluated.
Diffuse goiter may be the first sign of TM, and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.
Core Tip: This is a case report of metastasis to the thyroid gland (TM) from primary breast cancer presenting as diffuse goiter associated with skip metastases (SMs) to the contralateral cervical lymph nodes. The patient presented with a cervical mass and progressive neck swelling that were found to be metastases with altered immunostaining profiles upon fine-needle aspiration cytology. These findings indicate that rapidly occurring diffuse goiter without nodules may be the first sign of TM and that enlarged lymph nodes in the contralateral cervical area may be SMs of breast cancer. Raising awareness of these clinical presentations is helpful for the early detection of metastatic disease.