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Vol. 57, No. 2, 2013
Issue release date: March – April
Acta Cytologica 2013;57:177–183

Malignant Pleural Effusion Resulting from Metastasis of Thyroid Primaries: A Cytomorphological Analysis

Olson M.T. · Nuransoy A. · Ali S.Z.
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA

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Background: Malignant serous cavity effusion caused by primary thyroid cancer is extremely rare in routine clinical practice. Therefore, it is often not included in the differential diagnostic workup of patients presenting with positive effusion cytology. Methods: The clinical features were reviewed for 6 patients seen at our institution over the last 26 years for malignant effusion resulting from metastatic thyroid cancer. The cytomorphology from 4 of these cases was also reviewed. Results: All of the patients found in this study presented with malignant pleural effusion – other serous cavity effusions resulting from metastatic thyroid carcinoma were not seen. These comprised 0.25% of all patients with a known history of thyroid carcinoma and 0.67% of all malignant pleural effusions. One patient had a history of bone metastases, but all the others had no pathological evidence of distant metastatic disease prior to the pleural effusion. Conclusions: Malignant pleural effusion rarely results from a thyroid carcinoma after some latency. The diagnosis requires immunohistochemical staining as well as the pertinent clinical context.

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  1. Nasser H, Kuntzman TJ: Pleural effusion in women with a known adenocarcinoma: the role of immunostains in uncovering another hidden primary tumor. Acta Cytologica 2011;55:438–444.
  2. Chernow B, Sahn SA: Carcinomatous involvement of the pleura. Am J Med 1977;63:695–702.
  3. Fentiman IS, Millis R, Sexton S, Hayward JL: Pleural effusion in breast cancer: a review of 105 cases. Cancer 1981;47:2087–2092.
  4. Vassilopoulou-Sellin R, Sneige N: Pleural effusion in patients with differentiated papillary thyroid cancer. South Med J 1994;87:1111–1116.
  5. Mihailescu DV, Mustafa N, Barengolts E, Blumenthal S, Hatipoglu B: Papillary thyroid cancer presenting as a neck mass and massive pleural effusion. Endocrinologist 2010;20:10.

    External Resources

  6. Hsu K-F, Hsieh C-B, Duh Q-Y, Chien C-F, Li H-S, Shih M-L: Hürthle cell carcinoma of the thyroid with contralateral malignant pleural effusion. Onkologie 2009;32:47–49.
  7. Siddaraju N, Viswanathan VK, Saka VK, Basu D, Shanmugham C: Fine needle aspiration of follicular variant of papillary thyroid carcinoma presenting with pleural effusion: a case report. Acta Cytologica 2007;51:911–915.
  8. Mathur A, Moses W, Rahbari R, Khanafshar E, Duh Q-Y, Clark O, et al: Higher rate of BRAF mutation in papillary thyroid cancer over time: a single-institution study. Cancer 2011;117:4390–4395.
  9. Gordon IO, Sitterding S, Mackinnon AC, Husain AN: Update in neoplastic lung diseases and mesothelioma. Arch Pathol Lab Med 2009;133:1106–1115.
  10. Weissferdt A, Moran CA: Anaplastic thymic carcinoma: a clinicopathologic and immunohistochemical study of 6 cases. Hum Pathol 2012;43:874–877.
  11. Ross H, Martignoni G, Argani P: Renal cell carcinoma with clear cell and papillary features. Arch Pathol Lab Med 2012;136:391–399.
  12. Bishop JA, Sharma R, Westra WH: PAX8 immunostaining of anaplastic thyroid carcinoma: a reliable means of discerning thyroid origin for undifferentiated tumors of the head and neck. Hum Pathol 2011;42:1873–1877.
  13. Kim J-H, Choi YD, Lee JS, Lee JH, Nam JH, Choi C: Utility of thyroid transcription factor-1 and CDX-2 in determining the primary site of metastatic adenocarcinomas in serous effusions. Acta Cytologica 2010;54:277–282.
  14. Cimino-Mathews A, Ali SZ: Metastatic urothelial carcinoma with signet ring features: cytomorphologic findings in abdominal paracentesis. Diagn Cytopathol 2011;39:132–134.
  15. Yousem SA: Pulmonary intestinal-type adenocarcinoma does not show enteric differentiation by immunohistochemical study. Mod Pathol 2005;18:816–821.
  16. Parwani AV, Chan TY, Ali SZ: Significance of psammoma bodies in serous cavity fluid. Cancer 2004;102:87–91.
  17. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V: Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 1992;164:658–661.
  18. Dahl PR, Brodland DG, Goellner JR, Hay ID: Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol 1997;36:531–537.
  19. Salvati M, Frati A, Rocchi G, Masciangelo R, Antonaci A, Gagliardi FM, Delfini R: Single brain metastasis from thyroid cancer: report of twelve cases and review of the literature. J Neurooncol 2001;51:33–40.
  20. Siironen P, Hagström J, Mäenpää HO, Louhimo J, Heikkilä A, Heiskanen I, et al: Anaplastic and poorly differentiated thyroid carcinoma: therapeutic strategies and treatment outcome of 52 consecutive patients. Oncology 2010;79:400–408.
  21. Dinneen SF, Valimaki MJ, Bergstralh EJ, Goellner JR, Gorman CA, Hay ID: Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades. J Clin Endocrinol Metab 1995;80:2041–2045.

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