Diagnosis and Treatment > Investigation > Mammogram

You are looking at 1 - 2 of 2 items

Pratima Herle Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
General Surgery, Mount Druitt Hospital, Mount Druitt, New South Wales, Australia

Search for other papers by Pratima Herle in
Google Scholar
PubMed
Close
,
Steven Boyages Department of Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia

Search for other papers by Steven Boyages in
Google Scholar
PubMed
Close
,
Rina Hui Department of Radiation Oncology, Sydney West Cancer Network, Sydney, New South Wales, Australia

Search for other papers by Rina Hui in
Google Scholar
PubMed
Close
,
Najmun Nahar Department of Medical Oncology, Sydney West Cancer Network, Sydney, New South Wales, Australia

Search for other papers by Najmun Nahar in
Google Scholar
PubMed
Close
, and
Nicholas K Ngui General Surgery, Mount Druitt Hospital, Mount Druitt, New South Wales, Australia

Search for other papers by Nicholas K Ngui in
Google Scholar
PubMed
Close

Summary

In most developed countries, breast carcinoma is the most common malignancy in women and while thyroid cancer is less common, its incidence is almost three to five times greater in women than in men. Since 1966, studies have demonstrated an association between thyroid and breast cancer and despite these studies, the mechanism/s by which they are related, remains unclear. We present a case of a 56-year-old lady who initially presented in 2014 with a screen detected left breast carcinoma but was subsequently found to have occult metastatic thyroid cancer to the axilla, diagnosed from a sentinel node biopsy from the primary breast procedure. The patient underwent a left mastectomy, left axillary dissection and total thyroidectomy followed by three courses of radioactive iodine ablation. Despite this, her thyroglobulin level continued to increase, which was secondary to a metastatic thyroid cancer parasternal metastasis. Breast and thyroid cancer presents metachronously or synchronously more often than by chance. With improving mortality in primary cancers, such as breast and differentiated thyroid cancer, it is likely that as clinicians, we will continue to encounter this association in practice.

Learning points:

  • There has been a long-standing observation of an association between breast and thyroid cancer although the exact mechanism of this association remains unclear.

  • Our patient presented with thyroid cancer with an incidental diagnosis from a sentinel node biopsy during her primary breast operation for breast cancer and was also found to have a parasternal distant bony metastasis.

  • Thyroid axillary metastases are generally rare.

  • The interesting nature in which this patient’s metastatic thyroid carcinoma behaved more like a breast carcinoma highlights a correlation between these two cancers.

  • With improving mortality in these primary cancers, clinicians are likely to encounter this association in clinical practice.

  • Systemic therapy for metastatic breast and thyroid cancers differ and therefore a clear diagnosis of metastasis is crucial.

Open access
Ana G Ferreira Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal

Search for other papers by Ana G Ferreira in
Google Scholar
PubMed
Close
,
Tiago N Silva Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal

Search for other papers by Tiago N Silva in
Google Scholar
PubMed
Close
,
Henrique V Luiz Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal

Search for other papers by Henrique V Luiz in
Google Scholar
PubMed
Close
,
Filipa D Campos Hemato-Oncology Department, Garcia de Orta Hospital, Almada, Portugal

Search for other papers by Filipa D Campos in
Google Scholar
PubMed
Close
,
Maria C Cordeiro Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal

Search for other papers by Maria C Cordeiro in
Google Scholar
PubMed
Close
, and
Jorge R Portugal Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal

Search for other papers by Jorge R Portugal in
Google Scholar
PubMed
Close

Sellar plasmacytomas are rare and the differential diagnosis with non-functioning pituitary adenomas might be difficult because of clinical and radiological resemblance. They usually present with neurological signs and intact anterior pituitary function. Some may already have or eventually progress to multiple myeloma. We describe a case associated with extensive anterior pituitary involvement, which is a rare form of presentation. A 68-year-old man was referred to our Endocrinology outpatient clinic due to gynecomastia, reduced libido and sexual impotence. Physical examination, breast ultrasound and mammography confirmed bilateral gynecomastia. Blood tests revealed slight hyperprolactinemia, low testosterone levels, low cortisol levels and central hypothyroidism. Sellar MRI showed a heterogeneous sellar mass (56 × 60 × 61 mm), initially suspected as an invasive macroadenoma. After correcting the pituitary deficits with hydrocortisone and levothyroxine, the patient underwent transsphenoidal surgery. Histological examination revealed a plasmacytoma and multiple myeloma was ruled out. The patient was unsuccessfully treated with radiation therapy (no tumor shrinkage). Myeloma ultimately developed, with several other similar lesions in different locations. The patient was started on chemotherapy, had a bone marrow transplant and is now stable (progression free) on lenalidomide and dexamethasone. The presenting symptoms and panhypopituitarism persisted, requiring chronic replacement treatment with levothyroxine, hydrocortisone and testosterone.

Learning points:

  • Plasmacytomas, although rare, are a possible type of sellar masses, which have a completely different treatment approach, so it is important to make the correct diagnosis.

  • Usually, they present with neurological signs and symptoms and a well-preserved pituitary function, but our case shows that anterior pituitary function can be severely compromised.

  • Making a more extensive evaluation (clinical and biochemical) might provide some clues to this diagnosis.

Open access