Curious Residents of the Thyroid Gland: Two Case Reports of Colorectal Carcinoma Metastasis by Fine-Needle Aspiration Diagnosis

Abstract

Background: The most frequent metastases to the thyroid originate in the kidney, lung or breast. Colorectal adenocarcinoma represents less than 4% of metastases to the thyroid gland. Solitary metastases of colorectal cancer with no other manifestation of disseminated cancer disease are exceedingly rare. Within the Bethesda Classification for Reporting ­Thyroid Cytopathology, metastases are included in Diagnostic Categories “Suspicious for Malignancy” and “Malignant.” Cases: We present 2 cases of colorectal adenocarcinoma metastatic to the thyroid gland, diagnosed by fine-needle aspiration (FNA). One metastasis occurred in normal thyroid parenchyma; the other was a tumour-to-tumour metastasis into a follicular carcinoma of the thyroid. The latter is the first published tumour-to-tumour metastasis of a colorectal carcinoma in the thyroid from which both components were diagnosed by FNA. Conclusion: Diagnosing a metastasis to the thyroid is challenging. On FNA, a dual cell population should raise suspicion. Immunocytochemical and molecular analysis may be helpful. Clinical information is essential in guiding specific ancillary technique panels in scant cellular material.