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Squamous cell carcinoma of the thyroid gland: primary or secondary disease?

Published online by Cambridge University Press:  18 October 2010

M I Syed ,
M Stewart ,
S Syed ,
S Dahill ,
C Adams ,
D R McLellan  and
L J Clark
M I Syed*
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Southern General Hospital, Greater Glasgow and Clyde NHS Trust, Glasgow, UK
M Stewart
Affiliation:
Departments of Otolaryngology and Head and Neck Surgery, Royal Alexandra Hospital, Greater Glasgow and Clyde NHS Trust, Paisley, Scotland, UK
S Syed
Affiliation:
Departments of Otolaryngology and Head and Neck Surgery, Royal Alexandra Hospital, Greater Glasgow and Clyde NHS Trust, Paisley, Scotland, UK
S Dahill
Affiliation:
Department of Histopathology, Royal Alexandra Hospital, Greater Glasgow and Clyde NHS Trust, Paisley, Scotland, UK
C Adams
Affiliation:
Department of Radiology, Royal Alexandra Hospital, Greater Glasgow and Clyde NHS Trust, Paisley, Scotland, UK
D R McLellan
Affiliation:
Department of Histopathology, Southern General Hospital, Greater Glasgow and Clyde NHS Trust, Glasgow, UK
L J Clark
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Southern General Hospital, Greater Glasgow and Clyde NHS Trust, Glasgow, UK
*
Address for correspondence: Mr Mohammed Iqbal Syed, Specialist Registrar in Otolaryngology, Southern General Hospital, Greater Glasgow and Clyde NHS Trust, Glasgow G51 4TF, Scotland, UK Fax: +44 (0)141 3146616 E-mail: iqbalms@hotmail.com
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Abstract

Objective:

To review the aetiopathogenesis, clinical characteristics, immunohistochemical profile, prognosis and treatment options for primary thyroid squamous cell carcinoma, and to compare it with squamous cell carcinoma metastatic to the thyroid, thus providing the reader with a framework for differentiating primary and secondary disease.

Method:

Review of English language literature from the past 25 years.

Search strategy:

A search of the Medline, Embase and Cochrane databases (April 1984 to April 2009) was undertaken to enable a comprehensive review.

Results:

After applying strict criteria for the diagnosis of primary thyroid squamous cell carcinoma, 28 articles were identified reporting 84 cases. When reviewing secondary thyroid squamous cell carcinoma, we only analysed cases of squamous cell carcinoma metastatic to the thyroid gland, and found 28 articles reporting 78 cases.

Conclusion:

It is possible to differentiate between primary and secondary thyroid squamous cell carcinoma, on the basis of combined evidence from clinical examination and endoscopic, pathological and radiological evaluation. Such differentiation is important, as the prognosis for primary squamous cell carcinoma is uniformly poor irrespective of treatment, and the most suitable option may be supportive therapy. Treatment for secondary squamous cell carcinoma of the thyroid varies with the site and extent of spread of the primary tumour.

Keywords

Thyroid NeoplasmsTumour MetastasisSquamous Carcinoma
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 1 , January 2011 , pp. 3 - 9
Copyright
Copyright © JLO (1984) Limited 2010

Introduction

By definition, ‘squamous cell carcinoma of [the] thyroid should be composed entirely of tumour cells with squamous differentiation’.Reference Lam, Sakamoto, Delellis, Lloyd, Heitz and Eng1 This definition gains importance when one considers that up to 43 per cent of papillary carcinomas will contain regions of squamous cell metaplasia, and that many anaplastic carcinomas will be composed, in part, of squamoid regions.Reference Katoh, Sakamoto, Kasai and Yagawa2 Additionally, adenosquamous cell carcinomas have a squamous element.

Squamous cell carcinoma (SCC) of the thyroid gland is a rare entity. It can represent either primary SCC of the thyroid gland itself or secondary involvement of the gland, due to either extension of SCC from an adjacent structure or metastasis from a distant SCC. Direct extension and metastatic involvement of the thyroid gland are more common than generally realised, occurring approximately 10 times more frequently than primary thyroid SCC.Reference Goldman3

Primary SCC of the thyroid constitutes less than 1 per cent of all primary thyroid carcinomas.Reference Korovin, Kuriloff, Cho and Sobol4 Sporadic cases have been reported in literature, with most being derived from autopsy studies.

Advanced primary carcinomas of adjacent structures such as the tongue base, larynx, pharynx or upper oesophagus can directly invade the thyroid gland, and the gland may be the seat of metastases from SCC of the lung, head, neck or gastrointestinal tract. Despite its rich vasculature, the incidence of metastasis in the thyroid gland is low and accounts for only 2–3 per cent of all malignant tumours of the thyroid gland,Reference Cichoń, Anielski, Konturek, Barczyński and Cichoń5 of which SCC forms only a small fraction.

Materials and methods

Medical literature available in English was reviewed by searching the Pubmed, Embase and Cochrane databases using the medical subject headings ‘squamous cell carcinoma of thyroid’, ‘primary squamous cell carcinoma of thyroid’, ‘secondary squamous cell carcinoma of thyroid’ and ‘metastases to the thyroid’, for articles published in the last 25 years (April 1984 to April 2009).

When reviewing secondary thyroid SCC, we analysed only those cases of SCC metastatic to the thyroid gland: we excluded cases of thyroid SCC which had spread from adjacent structures (e.g. tongue base, larynx, pharynx and proximal oesophagus).

The literature on metastatic involvement of the thyroid gland by SCC is difficult to analyse and compare for many reasons. We could identify no other studies specifically addressing metastasis of SCC to the thyroid gland. Most studies have analysed metastasis to the thyroid gland from a heterogeneous group of cancers. Therefore, comments from these studies regarding prognosis and management cannot be specifically applied to metastasis of SCC to the thyroid gland.

In addition, many reports are based on autopsy studies, and the unavailability of immunohistochemical analysis in earlier times makes some of the diagnoses of this era questionable.

We excluded from this review the following cases: those in which the diagnosis was based only on fine needle aspiration cytology (FNAC), without immunohistochemical analysis; those in which computed tomography (CT) scanning or autopsy were not done to exclude a primary;Reference Segal, Sidi, Abraham, Konichezky and Ben-Bassat6 and those in which SCC was present in association with other thyroid malignancies such as papillary carcinoma,Reference Walvekar, Kane and D'Cruz7, Reference Kleer, Giordano and Merino8 adenocarcinomaReference Segal, Sidi, Abraham, Konichezky and Ben-Bassat6 or anaplastic carcinoma.Reference Katoh, Sakamoto, Kasai and Yagawa2

Results

Applying the above criteria, we identified 28 case reports or case series, reporting a total of 84 cases of primary SCC of the thyroid gland occurring over the last 25 years. We analysed the treatment modalities and survival time (in months) for each of these patients, as outlined in Table I.

Table I Primary thyroid SCC treatment and survival: 25-year review

*Where primary treatment differed amongst a group of patients, numbers undergoing each treatment type are given in parentheses. †One or more patients still alive at time of writing. SCC = squamous cell carcinoma; med = median; mth = months; surg = surgery; RT = radiotherapy; CT = chemotherapy; adj = adjuvant

Table II lists the literature on metastasis to the thyroid gland published over the last 25 years (28 articles reporting 78 cases). In this table, we have attempted to separate out cases of SCC metastases to the thyroid gland, and to list their primary site(s). The lung was found to be the commonest primary site.

Table II Metastases to the thyroid gland: 25-year review

*Of metastasis. †One or more patients still alive at time of writing. SCC = squamous cell carcinoma; med = median; mth = months

Discussion

Aetiopathogenesis

Primary SCC of the thyroid gland is an extremely rare neoplasm, representing less than 1 per cent of all primary thyroid malignancies.Reference Korovin, Kuriloff, Cho and Sobol4

The thyroid gland does not normally contain squamous epithelium; therefore, the origin of primary SCC within the thyroid remains controversial. Several hypotheses have been proposed, but every theory has been disputed.

One of the earliest theories was proposed by Goldberg and Harvey,Reference Goldberg and Harvey63 who believed that squamous cells were derived from the embryonic remnants of the thyroglossal duct. In early embryonic life, the thyroid gland migrates downwards, and a duct may persist lined by squamous, columnar or transitional epithelium. Normally, this duct completely involutes, but if it persists it may be the source of a thyroglossal cyst or epidermoidal carcinoma. This theory has been challenged by many. The lowest part of the thyroglossal duct forms the pyramidal lobe of the thyroid gland, and if these squamous cells were to give rise to malignancy then SCC would be expected to arise in the pyramidal lobe of the thyroid gland. However, clinically, most of the reported cases of primary SCC of the thyroid originate in the lateral lobe(s).

Branchial arch remnants (e.g. the ultimobranchial body and thymic epithelium) have also been suggested as sources of squamous epithelium,Reference Goldman3 but these theories remain largely unproven.

A recent theory proposed that the cell of origin of pure SCC arises due to squamous metaplasia.Reference Sahoo, Bal and Bhatnagar19 However, this appears unconvincing since the clinical conditions associated with squamous metaplasia (e.g. Hashimoto's thyroiditis) are rarely associated with primary SCC; the reviewed literature contained only three reported cases of primary SCC of the thyroid arising in association with chronic thyroiditis.Reference Korovin, Kuriloff, Cho and Sobol4, Reference Chaudhary, Barnes and Myers26, Reference Kobayashi, Okamoto, Maruyama, Okamura, Takai and Mori64 Secondary involvement of the thyroid gland by SCC is far more common, and can occur by direct local invasion from tumours in adjacent structures (e.g. the larynx, pharynx, proximal oesophagus, trachea, soft tissues or mediastinum), or from metastases from other sites giving rise to primary SCC (e.g. the lung, head, neck and gastrointestinal tract). Amongst SCCs of the head and neck, laryngeal and pharyngeal SCCs seem to have the greatest tendency to invade the thyroid by direct extension.Reference Nakhjavani, Gharib, Goellner and Heerden65

Gulisano et al. Reference Gulisano, Pirino and Montella66 attempted to find the route of metastatic spread to the thyroid gland. In three patients with pharyngeal SCC, they injected methylene blue into the submucosa of the pyriform sinus, before commencing the surgical procedure, which included hemithyroidectomy. The superior portion of the thyroid lobe stained, from which they concluded that tumour cells tend to follow periarterial lymphatic vessels.

Clinical features

Clinically, primary thyroid SCC is very aggressive; in this respect, it resembles anaplastic thyroid carcinoma.Reference Segal, Sidi, Abraham, Konichezky and Ben-Bassat6 Patients typically present with a rapidly increasing neck mass invading the strap muscles, soft tissues and blood vessels of the neck, compressing the trachea and oesophagus, and having accompanying cervical lymphadenopathy. Dysphagia, dyspnoea, hoarseness and neck pain typically ensue. In contrast to primary thyroid SCC, secondary invasion of the thyroid gland from adjacent structures such as the larynx or tongue base is usually discovered at surgery, and confirmed by histological examination.Reference Nakhjavani, Gharib, Goellner and Heerden65 Occasionally, the presentation may be that of a neck mass, as sometimes seen in cases of proximal oesophageal SCC extending to the thyroid gland.

The clinical presentation of SCC metastases to the thyroid gland can be variable, depending largely on the extent of the primary tumour.

Lam and LoReference Lam and Lo53 studied a series of patients with metastases to the thyroid; five of these cases were SCC, only one of which presented with an enlarging neck mass, the rest being discovered at autopsy. In contrast, Papi and colleagues'Reference Papi, Fadda, Corsello, Corrado, Rossi and Radighieri40 case series included 11 primary thyroid SCC cases, seven of which presented clinically as a thyroid nodule.

Diagnosis

The diagnosis of thyroid SCC involves a combination of clinical examination plus endoscopic, pathological and radiological evaluation.

It is vital to exclude secondary involvement of the thyroid, from primary SCC in adjacent structures and from metastasis from the head, neck, chest, upper digestive tract and pelvis, before making a diagnosis of primary thyroid SCC.

Endoscopy

Panendoscopy should be performed to exclude a primary lesion in the nasopharynx, oropharynx, hypopharynx, larynx, oesophagus or bronchus.

Radiology

There are no specific radiological features of thyroid SCC. Features similar to those seen in other thyroid malignancies are present. Ultrasound (US) is usually the first radiological modality used in the diagnostic investigation of a thyroid lump. The examination is simple and cost-effective, and is able to distinguish solid from cystic lesions and to define the echogenic pattern, which may suggest a benign or malignant tumour. Moreover, US-guided FNAC or core biopsy are also useful diagnostic modalities when combined with clinical and radiological findings.

Although CT is preferred, both CT and magnetic resonance imaging (MRI) scans are useful for the assessment of suspicious thyroid lumps. They allow differentiation of a thyroid mass from adjoining neck masses, and also enable assessment of the adjacent larynx and trachea to discern displacement, luminal narrowing, and vascular displacement and invasion. Evaluation should also assess calcification, cyst formation, necrosis, haemorrhage, lesion margin definition and extraglandular extension.Reference Weber, Randolph and Aksoy67

Computed tomography of the chest, abdomen and pelvis helps exclude a primary source for secondary SCC of the thyroid gland.

Primary thyroid SCC often tends to encase the oesophagus rather than invade it, leaving a fat plane between the tumour and the oesophagus, which is useful in confirming that the tumour arose from the thyroid rather than the oesophagus itself.

Metastatic disease may manifest as a solitary nodular mass or, more commonly, as multiple nodular foci; in a patient with a known primary tumour, this should raise strong suspicion of metastatic disease. In addition to CT and MRI, positron emission tomography may provide useful information enabling the identification of a primary tumour in patients with occult SCC metastases to the thyroid gland.Reference Macapinlac68

Pathology

Historical autopsy reports of primary thyroid SCC published prior to the availability of immunohistochemistry should be treated with caution. It is possible that earlier reports of primary thyroid SCC actually represent cases of secondary involvement of the thyroid from primary tumours in the trachea or oesophagus.Reference Goldman3

By definition, ‘squamous cell carcinoma of [the] thyroid should be composed entirely of tumour cells with squamous differentiation’.Reference Lam, Sakamoto, Delellis, Lloyd, Heitz and Eng1 However, half of primary thyroid SCC tumours are poorly differentiated. Although metastatic tumours generally retain the histological features of the primary tumour, they are frequently more poorly differentiated. The definition above should therefore be treated with caution. Primary thyroid SCC is also excluded if other types of thyroid carcinoma are present in close proximity.

A metastasis from another site should always be excluded before making a diagnosis of primary thyroid SCC.

Fine needle aspiration cytology is of limited value, partly due to the prevalence of poorly differentiated SCC, and partly due to the inability of FNAC to reliably distinguish between primary and metastatic SCC (although it is possible that immunocytochemistry may help clarify the diagnosis).

Macroscopically, primary thyroid SCC typically involves one or both lobes of the thyroid gland, although satellite tumour nodules have been reported. In contrast, metastases to the thyroid are most often multifocal.Reference DeLellis69

Immunohistochemistry may be useful in distinguishing primary from metastatic thyroid SCC.

The pattern of cytokeratin expression is different in carcinomas arising from different organs, and also varies with tumour differentiation.Reference Lam, Lo and Liu20 It has been reported that primary thyroid SCC is strongly positive for cytokeratin 19 but negative for cytokeratins 1, 4, 10/13 and 20.Reference Lam, Lo and Liu20, Reference Lam, Lui and Lo70 Focal positivity for cytokeratins 7 and 18 may be present in some tumours.

Occasional cases of thyroid SCC have been reported as positive for thyroglobulin, but this probably represents non-specific absorption from adjacent cells.Reference Kumar, Malekhusseini and Talei24

Thyroid transcription factor 1 expression is widely used in the diagnosis of lung and thyroid carcinomas. Thyroid transcription factor 1 is highly specific for lung and thyroid carcinoma,Reference Ordóñez71–Reference Pelosi, Fraggetta, Pasini, Maisonneuve, Sonzogni and Iannucci73 and is positive in thyroid cancers regardless of histological type.Reference Dabbs74 It is also positive in 10Reference Dabbs74 to 30Reference Corrin and Nicholson75 per cent of lung SCC cases.

One of our own cases (not published) was thyroid transcription factor 1 positive; primary lung carcinoma was excluded by extensive clinical and radiological assessment.

Another useful marker to be considered is calcitonin, the analysis of which enables exclusion of medullary thyroid carcinoma.

Prognosis and management

Primary thyroid SCC portends a poor prognosis regardless of therapy; secondary involvement of the thyroid, however, may be more amenable to treatment.Reference Korovin, Kuriloff, Cho and Sobol4

Analysis of published survival rates for the last 25 years (Table I) shows that median survival for primary thyroid SCC is poor. Ideally, survival rates for specific tumour stages should be reported, but unfortunately most case series do not mention patients' tumour stage.

Various combinations of surgery, radiotherapy and chemotherapy have been used in the treatment of primary SCC of the thyroid.

Primary thyroid SCC extensively infiltrates and invades adjacent tissue, even when small (e.g. 1–3 cm in diameter), making surgical resection extremely difficult and frequently impossible.Reference Zhou18

Primary thyroid SCC has been widely reported to be relatively radio-resistant, and this conclusion is well documented in the older literature.Reference Huang and Assor76–Reference Kukreti, Prabhune, Upadhyaya and Shah79

Even with modern radiotherapy techniques, there has been little change in radiotherapy response rates in recent times. Sarda et al. Reference Sarda, Bal, Arunabh, Singh and Kapur31 reported eight patients with primary thyroid SCC who were treated with post-operative chemoradiotherapy; seven out of these eight died of local recurrence within five months of surgery. In 2006, Booya et al. Reference Booya, Sebo, Kasperbauer and Fatourechi15 reported a series of 10 cases all of which received adjuvant radiation; these patients' median survival was 8.6 months.

The relative rarity of primary thyroid SCC makes any evaluation of chemotherapy statistically inconclusive. However, the literature indicates that chemotherapy used as an adjuvant has had disappointing results. Harada et al. Reference Harada, Shimaoka, Yakumaru and Ito80 reported unimpressive responses to bleomycin and to adriamycin. Shimaoka and TsukadaReference Shimaoka and Tsukada78 administered nitrogen mustard, vincristine, adriamycin and AB-132 for four cases of primary thyroid SCC, but none showed any encouraging response. Similarly, other authorsReference Segal, Sidi, Abraham, Konichezky and Ben-Bassat6, Reference Booya, Sebo, Kasperbauer and Fatourechi15, Reference Cook, Vini and Harmer23, Reference Simpson and Carruthers30, Reference Sarda, Bal, Arunabh, Singh and Kapur31 have used chemotherapy for primary thyroid SCC but reported little benefit.

As with anaplastic thyroid carcinoma, primary thyroid SCC does not take up radioactive iodine, and thyroid-stimulating hormone suppression has little impact.Reference Harmer and Horwich81

Definite conclusions about the effect of chemoradiation on primary thyroid SCC cannot be drawn, due to the small number of reported cases. However, continuing modernisation in radiation techniques and advances in chemotherapy may mean that chemoradiation plays a more important role in future management of this tumour.

The cause of death in most primary thyroid SCC cases is progression of local disease, respiratory compromise, distant metastasis or treatment complications.Reference Zimmer, Wilson and Bell17, Reference Lam, Lo and Liu20

Based upon our own experience of managing primary thyroid SCC patients, and upon the fact that surgery, radiation and chemotherapy in any reported combination have little or no impact in improving outcome or prolonging survival, we recommend tracheostomy (to protect the airway, as respiratory compromise is the commonest cause of death in these patients), PEG (Percutaneous endoscopic gastrostomy) or open gastrostomy (as dysphagia from oesophageal invasion is common), and supportive treatment, rather than radical chemoradiation and surgery. The latter are by no means curative, and there is little evidence to show that they prolong life. However, there remains a limited but important role for palliative surgery, in the form of total thyroidectomy to relieve severe airway obstruction.

The management of SCC metastasis to the thyroid is poorly documented in the literature, primarily because the majority of reports are derived from pathology journals that do not comment on patient management or prognosis. In addition, the site of primary disease is so variable (including tongue, tonsil, larynx, oesophagus, cervix and bladder) that general comments about treatment cannot be made. Management depends on the site and stage of the primary tumour, the presence of other metastases, and the symptoms caused by the thyroid metastases.

We recommend that patients with treatable primary SCC should undergo total thyroidectomy for isolated metastases to the thyroid gland, not only to prolong survival but also to prevent further dissemination of the tumour (taking into account the rich blood supply of the thyroid gland, which would favour leakage of tumour emboli into the systemic circulation).Reference Ericsson, Biörklund, Cederquist, Ingemansson and Akerman82

Conclusion

Squamous cell carcinoma of the thyroid gland is an uncommon condition and represents a diagnostic dilemma both for the otolaryngologist, who needs a thorough evaluation, and the pathologist. It is vital to differentiate primary and secondary involvement of the thyroid gland by SCC, as the prognosis and management of the two conditions can differ significantly.Reference Ericsson, Biörklund, Cederquist, Ingemansson and Akerman82

References

1 Lam, KY, Sakamoto, A. Squamous cell carcinoma. In: Delellis, Ronald A., Lloyd, Ricardo V., Heitz, Phillipp U., Eng, Charis eds. Pathology and Genetics of Tumours of Endocrine Organs. Lyon France: ARC press, International agency for research and cancer (IARC), 2004;81Google Scholar
2 Katoh, R, Sakamoto, A, Kasai, N, Yagawa, K. Squamous differentiation in thyroid carcinoma. With special reference to histogenesis of squamous cell carcinoma of the thyroid. Acta Pathol Jpn 1989;39:306–12Google ScholarPubMed
3 Goldman, RL. Primary squamous cell carcinoma of the thyroid gland. Report of a case and review of literature. Am Surg 1964;30:247–52Google Scholar
4 Korovin, GS, Kuriloff, DB, Cho, HT, Sobol, SM. Squamous cell carcinoma of the thyroid: a diagnostic dilemma. Ann Otol Rhinol Laryngol 1989;98:59–65CrossRefGoogle ScholarPubMed
5 Cichoń, S, Anielski, R, Konturek, A, Barczyński, M, Cichoń, W. Metastases to the thyroid gland: seventeen cases operated on in a single clinical center. Langenbecks Arch Surg 2006;391:581–7CrossRefGoogle Scholar
6 Segal, K, Sidi, J, Abraham, A, Konichezky, M, Ben-Bassat, M. Pure squamous cell carcinoma and mixed adenosquamous cell carcinoma of the thyroid gland. Head Neck Surg 1984;6:1035–42CrossRefGoogle ScholarPubMed
7 Walvekar, RR, Kane, SV, D'Cruz, AK. Collision tumour of the thyroid: follicular variant of papillary carcinoma and squamous carcinoma. World J Surg Oncol 2006;19;4:65CrossRefGoogle Scholar
8 Kleer, CG, Giordano, TJ, Merino, MJ. Squamous cell carcinoma of the thyroid: an aggressive tumour associated with tall cell variant of papillary thyroid carcinoma. Mod Pathol 2000;13:742–6Google Scholar
9 Long, JL, Strocker, AM, Wang, MB, Blackwell, KE. EGFR expression in primary squamous cell carcinoma of the thyroid. Laryngoscope 2009;119:89–90CrossRefGoogle ScholarPubMed
10 Makay, O, Kaya, T, Ertan, Y, Icoz, G, Akyildiz, M, Yilmaz, M et al. Primary squamous cell carcinoma of the thyroid: report of three cases. Endocr J 2008;55:359–64CrossRefGoogle ScholarPubMed
11 Müssig, K, Dahm, J, Koitschev, A, Horger, M, Müller, M, Bares, R et al. Primary squamous cell carcinoma of the thyroid. Intern Med J 2008;38:69–70CrossRefGoogle ScholarPubMed
12 Fassan, M, Pennelli, G, Pelizzo, MR, Rugge, M. Primary squamous cell carcinoma of the thyroid: immunohistochemical profile and literature review. Tumori 2007;93:518–21CrossRefGoogle ScholarPubMed
13 Ab Hadi, I, Bliss, RD, Lennard, TW, Welch, AR. Primary squamous cell carcinoma of the thyroid gland: a case report and role of radiotherapy. Surgeon 2007;5:249–51CrossRefGoogle ScholarPubMed
14 Chintamani, Kulshreshtha, P, Singh, J, Sugandhi, N, Bansal, A, Bhatnagar, D et al. Is an aggressive approach justified in the management of an aggressive cancer – the squamous cell carcinoma of thyroid? Int Semin Surg Oncol 2007;27:8Google Scholar
15 Booya, F, Sebo, TJ, Kasperbauer, JL, Fatourechi, V. Primary squamous cell carcinoma of the thyroid: report of ten cases. Thyroid 2006;16:89–93CrossRefGoogle ScholarPubMed
16 Sanchez-Sosa, S, Rios-Luna, NP, Tamayo Bdel, R, Simpson, K, Albores-Saavedra, J. Primary squamous cell carcinoma of the thyroid arising in Hashimoto's thyroiditis in an adolescent. Pediatr Dev Pathol 2006;9:496–500Google Scholar
17 Zimmer, PW, Wilson, D, Bell, N. Primary squamous cell carcinoma of the thyroid gland. Mil Med 2003;168:124–5Google Scholar
18 Zhou, XH. Primary squamous cell carcinoma of the thyroid. Eur J Surg Oncol 2002;28:42–5Google Scholar
19 Sahoo, M, Bal, CS, Bhatnagar, D. Primary squamous-cell carcinoma of the thyroid gland: new evidence in support of follicular epithelial cell origin. Diagn Cytopathol 2002;27:227–31CrossRefGoogle ScholarPubMed
20 Lam, KY, Lo, CY, Liu, MC. Primary squamous cell carcinoma of the thyroid gland: an entity with aggressive clinical behaviour and distinctive cytokeratin expression profiles. Histopathology 2001;39:279–86CrossRefGoogle ScholarPubMed
21 Agrawal, R, Tandon, V, Agrawal, A, Agrawal, G, Krishnani, N, Mishra, SK. Squamous cell carcinoma of thyroid gland. J Assoc Physicians India 2001;49:279–80Google Scholar
22 Jones, JM, McCluggage, WG, Russell, CF. Primary squamous carcinoma of the thyroid. Ulster Med J 2000;69:58–60Google ScholarPubMed
23 Cook, AM, Vini, L, Harmer, C. Squamous cell carcinoma of the thyroid: outcome of treatment in 16 patients. Eur J Surg Oncol 1999;25:606–9Google Scholar
24 Kumar, PV, Malekhusseini, SA, Talei, AR. Primary squamous cell carcinoma of the thyroid diagnosed by fine needle aspiration cytology. A report of two cases. Acta Cytol 1999;43:659–62Google Scholar
25 Wan Muhaizan, WM, Phang, KS, Sharifah, NA, al Amin, D. Primary squamous cell carcinoma of the thyroid – a case report. Malays J Pathol 1998;20:109–11Google Scholar
26 Chaudhary, RK, Barnes, EL, Myers, EN. Squamous cell carcinoma arising in Hashimoto's thyroiditis. Head Neck 1994;16:582–5Google Scholar
27 Theander, C, Lödén, B, Berglund, J, Seidal, T. Primary squamous carcinoma of the thyroid – a case report. J Laryngol Otol 1993;107:1155–8CrossRefGoogle ScholarPubMed
28 Tsuchiya, A, Suzuki, S, Nomizu, T, Yamaki, Y, Abe, R, Katayama, S. Squamous cell carcinoma of the thyroid – a report of three cases. Jpn J Surg 1990;20:341–5Google Scholar
29 Harada, T, Katagiri, M, Tsukayama, C, Higashi, Y, Shimaoka, K. Squamous cell carcinoma with cyst of the thyroid. J Surg Oncol 1989;42:136–43Google Scholar
30 Simpson, WJ, Carruthers, J. Squamous cell carcinoma of the thyroid gland. Am J Surg 1988;156:44–6CrossRefGoogle ScholarPubMed
31 Sarda, AK, Bal, S, Arunabh, Singh, MK, Kapur, MM. Squamous cell carcinoma of the thyroid. J Surg Oncol 1988;39:175–8Google Scholar
32 Misonou, J, Aizawa, M, Kanda, M, Uekita, Y, Motohara, T. Pure squamous cell carcinoma of the thyroid gland – report of an autopsy case and review of the literature. Jpn J Surg 1988;18:469–74Google Scholar
33 Riddle, PE, Dincsoy, HP. Primary squamous cell carcinoma of the thyroid associated with leukocytosis and hypercalcemia. Arch Pathol Lab Med 1987;111:373–4Google ScholarPubMed
34 Huang, TY, Lin, SG. Primary squamous cell carcinoma of the thyroid. Indiana Med 1986;79:763–4Google Scholar
35 Kapoor, VK, Sharma, D, Mukhopadhyay, AK, Chattopadhyay, TK. Primary squamous cell carcinoma of the thyroid gland – a case report. Jpn J Surg 1985;15:60–2Google Scholar
36 Jankowska, P, Teoh, EM, Fisher, C, Rhys Evans, P, Nutting, CM, Harrington, KJ. Isolated intrathyroid metastasis from undifferentiated and squamous carcinoma of the head and neck: the case for surgery and re-irradiation. Br J Radiol 2008;81:154–61CrossRefGoogle ScholarPubMed
37 Lee, MW, Batoroev, YK, Odashiro, AN, Nguyen, GK. Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology. Cytojournal 2007;30:5CrossRefGoogle Scholar
38 Ciobanu, D, Vulpoi, C, Găluşcă, B, Florea, N, Giuşcă, SE, Căruntu, ID. The value of the immunohistochemical exam in the diagnosis of the secondary malignant tumors to the thyroid gland. Rom J Morphol Embryol 2007;48:113–19Google Scholar
39 Iesalnieks, I, Trupka, A, Raab, M, Glockzin, G, Woenckhaus, M, Schlitt, HJ et al. Renal cell carcinoma metastases to the thyroid gland – 8 cases reported. Thyroid 2007;17:49–52Google Scholar
40 Papi, G, Fadda, G, Corsello, SM, Corrado, S, Rossi, ED, Radighieri, E et al. Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience. Clin Endocrinol (Oxf) 2007;66:565–71CrossRefGoogle Scholar
41 Bandyopadhyay, SK, Bandyopadhyay, R, Dutta, A. Isolated massive thyroid metastasis in lung cancer. Singapore Med J 2006;47:324–6Google ScholarPubMed
42 Karapanagiotou, E, Saif, MW, Rondoyianni, D, Markaki, S, Alamara, C, Kiagia, M et al. Metastatic cervical carcinoma to the thyroid gland: a case report and review of the literature. Yale J Biol Med 2006;79:165–8Google Scholar
43 Gerges, AS, Shehata, SR, Gouda, IA. Metastasis to the thyroid gland; unusual site of metastasis. J Egypt Natl Canc Inst 2006;18:67–72Google Scholar
44 Preuss, SF, Stenzel, M, Hansen, T. Metastatic disease of bronchial carcinoma in a thyroid nodule: a case report. Eur Arch Otorhinolaryngol 2005;262:804–6Google Scholar
45 Mirallié, E, Rigaud, J, Mathonnet, M, Gibelin, H, Regenet, N, Hamy, A et al. Management and prognosis of metastases to the thyroid gland. J Am Coll Surg 2005;200:203–7Google Scholar
46 Kim, TY, Kim, WB, Gong, G, Hong, SJ, Shong, YK. Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy. Clin Endocrinol (Oxf) 2005;62:236–41CrossRefGoogle Scholar
47 Dequanter, D, Lothaire, P, Larsimont, D, de Saint-Aubain de Somerhausen, N, Andry, G. Intrathyroid metastasis: 11 cases. Ann Endocrinol (Paris) 2004;65:205–8Google Scholar
48 Wood, K, Vini, L, Harmer, C. Metastases to the thyroid gland: the Royal Marsden experience. Eur J Surg Oncol 2004;30:583–8Google Scholar
49 De Ridder, M, Sermeus, AB, Urbain, D, Storme, GA. Metastases to the thyroid gland – a report of six cases. Eur J Intern Med 2003;14:377–9Google Scholar
50 Schwender, FT, Wollner, I, Kunju, LP, Nakhleh, RE, Chan, KM. Squamous cell carcinoma of the buccal mucosa with metastases to the pericardial cavity, lung and thyroid. Oral Oncol 2002;38:114–16Google Scholar
51 Heffess, CS, Wenig, BM, Thompson, LD. Metastatic renal cell carcinoma to the thyroid gland: a clinicopathologic study of 36 cases. Cancer 2002;95:1869–78Google Scholar
52 Chen, H, Nicol, TL, Udelsman, R. Clinically significant, isolated metastatic disease to the thyroid gland. World J Surg 1999;23:177–80Google Scholar
53 Lam, KY, Lo, CY. Metastatic tumours of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med 1998;122:37–41Google Scholar
54 Lin, JD, Weng, HF, Ho, YS. Clinical and pathological characteristics of secondary thyroid cancer. Thyroid 1998;8:149–53CrossRefGoogle ScholarPubMed
55 Nakhjavani, MK, Gharib, H, Goellner, JR, van Heerden, JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer 1997;79:574–83.0.CO;2-#>CrossRefGoogle Scholar
56 Rosen, IB, Walfish, PG, Bain, J, Bedard, YC. Secondary malignancy of the thyroid gland and its management. Ann Surg Oncol 1995;2:252–6CrossRefGoogle ScholarPubMed
57 Michelow, PM, Leiman, G. Metastases to the thyroid gland: diagnosis by aspiration cytology. Diagn Cytopathol 1995;13:209–13CrossRefGoogle Scholar
58 Smith, SA, Gharib, H, Goellner, JR. Fine-needle aspiration. Usefulness for diagnosis and management of metastatic carcinoma to the thyroid. Arch Intern Med 1987;147:311–12CrossRefGoogle ScholarPubMed
59 Chacho, MS, Greenebaum, E, Moussouris, HF, Schreiber, K, Koss, LG. Value of aspiration cytology of the thyroid in metastatic disease. Acta Cytol 1987;31:705–12Google Scholar
60 McCabe, DP, Farrar, WB, Petkov, TM, Finkelmeier, W, O'Dwyer, P, James, A. Clinical and pathologic correlations in disease metastatic to the thyroid gland. Am J Surg 1985;150:519–23CrossRefGoogle Scholar
61 Ivy, HK. Cancer metastatic to the thyroid: a diagnostic problem. Mayo Clin Proc 1984;59:856–9Google Scholar
62 Vane, D, King, DR, Boles, ET Jr. Secondary thyroid neoplasms in pediatric cancer patients: increased risk with improved survival. J Pediatr Surg 1984,19:855–60CrossRefGoogle ScholarPubMed
63 Goldberg, HM, Harvey, P. Squamous-cell cysts of the thyroid with special reference to the aetiology of squamous epithelium in the human thyroid. Br J Surg 1956;43:565–9CrossRefGoogle Scholar
64 Kobayashi, T, Okamoto, S, Maruyama, H, Okamura, J, Takai, S, Mori, T. Squamous metaplasia with Hashimoto's thyroiditis presenting as a thyroid nodule. J Surg Oncol 1989;40:139–42Google Scholar
65 Nakhjavani, M, Gharib, H, Goellner, JR, Heerden, JA. Direct extension of malignant lesions to the thyroid gland from adjacent organs: report of 17 cases. Endocr Pract 1999;5:69–71Google Scholar
66 Gulisano, M, Pirino, A, Montella, A. Blood and/or lymphatic connection of laryngo-pharynx and thyroid: an anatomic and clinical problem (in Italian). Boll Soc Ital Biol Sper 1993;69:655–9Google Scholar
67 Weber, AL, Randolph, G, Aksoy, FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am 2000;38:1105–29Google Scholar
68 Macapinlac, HA. FDG-PET in head and neck, and thyroid cancer. Chang Gung Med J 2005;28:284–95Google Scholar
69 DeLellis, R. Secondary tumours of the thyroid. In: Pathology and Genetics of Tumours of Endocrine Organs. Lyon, France: IARC Press, International Agency for Research on Cancer, 2004;122–3Google Scholar
70 Lam, KY, Lui, MC, Lo, CY. Cytokeratin expression profiles in thyroid carcinomas. Eur J Surg Oncol 2001;27:631–5Google Scholar
71 Ordóñez, NG. Value of thyroid transcription factor-1 immunostaining in distinguishing small cell lung carcinomas from other small cell carcinomas. Am J Surg Pathol 2000;24:1217–23Google Scholar
72 Agoff, SN, Lamps, LW, Philip, AT, Amin, MB, Schmidt, RA, True, LD et al. Thyroid transcription factor-1 is expressed in extrapulmonary small cell carcinomas but not in other extrapulmonary neuroendocrine tumours. Mod Pathol 2000;13:238–42Google Scholar
73 Pelosi, G, Fraggetta, F, Pasini, F, Maisonneuve, P, Sonzogni, A, Iannucci, A et al. Immunoreactivity for thyroid transcription factor-1 in stage I non-small cell carcinomas of the lung. Am J Surg Pathol 2001;25:363–72Google Scholar
74 Dabbs, D. Immunohistology of endocrine tumours. In: Diagnostic Immunohistochemistry. Philadelphia: Churchill Livingstone, 2006;9:269Google Scholar
75 Corrin, B, Nicholson, AG. Tumours. In: Pathology of the Lungs. Edinburgh: Churchill Livingstone, 2005;12:675Google Scholar
76 Huang, TY, Assor, D. Primary squamous cell carcinoma of the thyroid gland: a report of four cases. Am J Clin Pathol 1971;55:93–8Google Scholar
77 Kampsen, EB, Jager, N, Max, MH. Squamous cell carcinoma of the thyroid: a report of two cases. J Surg Oncol 1977;9:567–78Google Scholar
78 Shimaoka, K, Tsukada, Y. Squamous cell carcinomas and adenosquamous carcinomas originating from the thyroid gland. Cancer 1980;15:1833–42Google Scholar
79 Kukreti, SC, Prabhune, PV, Upadhyaya, GH, Shah, HH. Primary squamous cell carcinoma of the thyroid gland. J Indian Med Assoc 1972;16:287–8Google Scholar
80 Harada, T, Shimaoka, K, Yakumaru, K, Ito, K. Squamous cell carcinoma of the thyroid gland – transition from adenocarcinoma. J Surg Oncol 1982;19:36–43Google Scholar
81 Harmer, C. Thyroid Cancer. In: Horwich, A, ed. Oncology. A Multidisciplinary Textbook. London: Chapman and Hall, 1995;565–84Google Scholar
82 Ericsson, M, Biörklund, A, Cederquist, E, Ingemansson, S, Akerman, M. Surgical treatment of metastatic disease in the thyroid gland. J Surg Oncol 1981;17:15–23Google Scholar
Figure 0

Table I Primary thyroid SCC treatment and survival: 25-year review

Figure 1

Table II Metastases to the thyroid gland: 25-year review