A case of pulsating sternal and clavicular metastases of thyrofollicular carcinoma

DESCRIPTION

Bony metastases are not infrequently encountered with follicular carcinoma of thyroid. Rarely, papillary thyroid carcinoma spreads to bones1; however, anterior chest wall (sternal and clavicular) involvement are rare. A 54-year-old man with long-standing (~25 years) multinodular goitre presented with recent-onset rapid enlargement of the sternoclavicular area beneath the goitre. On examination, the swelling was hard, warm and pulsatile and in addition showed engorged anterior chest wall veins (figure 1). He was clinically and biochemically euthyroid. Chest X-ray (figure 2) showed huge thyroid mass with sternal and clavicular erosion confirmed by CT (figure 3). Fine-needle aspiration cytology of the goitre and bony mass confirmed follicular carcinoma. He underwent total thyroidectomy with excision of the sternal and clavicular metastases and reconstruction of the chest wall defect with Marlex mesh. Following surgery, he underwent radioiodine therapy (200 mCi) and the post-therapy scan showed multiple pulmonary macronodular...

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