Abstract
A 57-year-old female had a total thyroidectomy for Hürthle cell carcinoma. Pathology revealed Hürthle cell carcinoma replacing the right thyroid lobe and isthmus and Hashimoto's thyroiditis in the left lobe. Panels A and B (Fig. 1) show the histological findings in the right thyroid (hematoxylin & eosin [H&E], X200) demonstrating large, polygonal Hürthle cells with abundant granular cytoplasm, moderately pleomorphic nuclei with mitosis (arrows). The tumor cells are arranged in follicles (Fig. 1A) with occasional papillary areas (Fig. IB). Postoperatively, the patient was treated with radioactive iodine and post ablative whole-body scan was negative for distant metastases. The patient presented 3 months later with a large right neck mass (approximately 4 X 54 cm) and fever. Fine-needle aspiration of the mass revealed malignant cells consistent with Hürthle cell carcinoma. Computed tomography (CT) scan of the chest showed multiple large cardiac masses in the right ventricle and right atrium, and an embolus occluding the right main pulmonary artery. Echocardiogram demonstrated two large masses with areas of necrosis in the right ventricle and right atrium (Fig. 2, arrows). Cardiac catheterization with biopsy was nondiagnostic and the patient underwent open heart biopsy which showed metastatic Hürthle cell carcinoma. Figure 1C and ID show the histology of the cardiac metastases of the Hürthle cell carcinoma involving the myocardium of the right atrium and the pericardium. The neoplastic Hürthle cells are arranged in small groups and follicles (Panel C) with occasional papillary areas (Fig. ID). The serum thyroglobulin level was undetectable. Intracardiac metastases of thyroid cancer are rare with only a few reported cases in the literature (1-3). It has been described with follicular, papillary and anaplastic carcinoma. Overall the prognosis is poor and the average survival is a few months (1-3).
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