Two cases of sternectomy for bone metastasis due to aggressive variants of thyroid papillary carcinoma

Abstract

Introduction: There are only few cases reported about the role of surgery in the presence of single or multiple bulky bone metastases. The literature about treatment for bulky sternal metastases is scarce.

Presentation of case: We present two patients treated surgically for metastatic thyroid lesions. Case 1 is a female with tumor of the thyroid right lobe, mediastinal extension and multiple pulmonary metastases. Bony infiltration was observed in the sternum and ribs. Case 2 is a female with a lesion in the cervical region of the thyroid left lobe and increase in volume on the upper sternal manubrium.

Discussion: Patients with well-differentiated thyroid cancer may present with extracervical metastasis in 5-10% of cases at diagnosis. Bone metastases occur in 0.4% of cases of papillary carcinoma. Management remains controversial. There are only isolated cases reported in the literature of the role surgery plays in the presence of single or multiple bulky bone metastases. The basis for initial surgical approach is keeping in mind that the surgical procedure is palliative in order to achieve optimal hypothetical ablation as a result of reduced tumor volume.

Conclusion: Surgery is the elective treatment and can be performed safely and with adequate results, allowing proper optimization of the dose of (131)I for ablative therapy.