Basal Cell Carcinoma and Thyroid Tumor ( Two Primary Tumors ) in Female 74 Years Old A Case Report.
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Basal Cell Carcinoma and Thyroid Tumor ( Two Primary Tumors )
in Female 74 Years Old : A Case Report
I Kt Wisudana Yuana 1, IB Made Suryawisesa, Pt Anda Tusta A, Gede Budhi Setiawan,
Kt Widiana, Wyn Sudarsa, INW Steven Christian, IB Tjakra Wibawa M 2
1 Resident of General Surgery , Faculty of Medicine,Udayana University –
Sanglah General Hospital Denpasar
2 Sub Division of Oncology Surgery, Faculty of Medicine, Udayana University –
Sanglah General Hospital Denpasar
Introduction
Basal cell carcinoma (BCC) is the most non melanoma skin cancer in humans. It
accounts for 20% of carcinomas in men and 10–15% of carcinomas in women. Approximately
75–86% of primary BCCs are found on the head or neck. The most common location on the head
is the nose, specifically the nasal tip and alae. Sun exposure is the primary etiologic agent for the
development of BCC.1,3,7
Thyroid tumor can be a benign tumor such as thyroid adenoma, or it can be a malignant
neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer.
Most patients are 25 to 65 years of age when first diagnosed, women are more affected than men.
Thyroid cancer is the most common endocrine malignancy, and its incidence is rising in the USA
and other countries. Papillary and follicular thyroid carcinomas are the two most common types
of thyroid cancer.3,4,5,8
Despite its high incidence, Basal cell carcinoma and thyroid tumor events are
exceedingly rare in one patient.3,8
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Case
A seventy four years old woman came to Sanglah Hospital with chief complain of tumor
on the right inferior palpebra and neck since 2 years ago. On physical examination, 3 cm firm,
tender, dark mass on the right inferior palpebra and on the left neck, thyroid mass was palpated
18 cm firm,tender ( Figure 1 ). There was no familial history of multiple tumors or cysts. History
of medicine unknown.
A computed tomography (CT) scan of the neck showed an 8-9 cm mass in the left lobe of
the thyroid gland, push the oropharynk to the right side, infiltrated m. longus colli and the left
m.sternocleidomastoid, and adhere on the left v.jugularis externa and interna ( Figure 2 ). Fine
needle aspiration (FNA) of the left thyroid gland then revealed a cytological interpretation of
suspicious for papillary carcinoma. And FNA of the right inferior palpebra interpretation of
basal cell carcinoma (BCC).
Figure 1. Tumor on the right inferior palpebra and left neck since 2 years ago.
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Figure 2. A computed tomography (CT) scan of the neck showed an 8-9 cm mass in the
left lobe of the thyroid gland
Discussion
Basal cell carcinoma (BCC) is the most common carcinoma in humans and accounts for
20% of carcinomas in men and 10–15% of carcinomas in women. Approximately 75–86% of
primary BCCs are found on the head or neck. The most common location on the head is the nose,
specifically the nasal tip and alae. It constitutes 90% of periorbital malignancies. Sun exposure is
the primary etiologic agent for the development of BCC. BCC arising on the medial canthus tends
to be deep and invasive and may result in perineural extension and loss of optic nerve function.
Pieh et al reported that the highest recurrence rates of BCC following attempted excision,
(approximately 60%), was seen with lesions arising from the medial canthus since these lesions
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tend to be more invasive and difficult to manage. Reclusive patients or patients who neglect the
lesions for long periods of time are more likely to have giant, invasive tumors. Giant BCC,
defined as lesions more than 5 cm at its largest diameter, are rare forms of BCC. Giant BCCs
more commonly appear on the trunk and display a more aggressive behavior, resulting in local
invasion and metastasis. The reported incidence of metastatic BCC ranges from 0.03 % to 0.55 ,
the most metastatic location are lung and parotid gland.1,3,5,7
Thyroid tumor can be a benign tumor such as thyroid adenoma, or it can be a malignant
neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer.
Most patients are 25 to 65 years of age when first diagnosed; women are more affected than
men. Thyroid cancer is the most common endocrine malignancy, and its incidence is rising in
the USA and other countries. Papillary and follicular thyroid carcinomas are the two most
common types of thyroid cancer.2,3,4,5,6
The patient then underwent a left isthmolobectomy and right excision basal cell
carcinoma and
reconstruction with cheek flap advancement ( Figure 3). Pathological
examination of the thyroid gland demonstrated cuboid epitel cell, Hurtle cell, cystic follicle with
variably-sized follicles, but no evidence of carcinoma. Sections of the right inferior palpebra
excision showed nodular basal cell carcinoma.The carcinoma was characterized by irregularly
shaped aggregates, nests and cords of basaloid cells with peripheral palisading and a variable
intervening fibrotic stroma.
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Figure 3. The patient underwent a left isthmolobectomy and right excision basal cell
carcinoma and reconstruction with cheek flap advancement.
Conclusion
Two primary tumors in one patient is a rare case, and we must carefully and differentiated
with the metastatic primary tumor. We can prove by the pathological examination, because the
other diagnostic maybe wrong.1,3,8
10
References
1.
Barry W.Feig, David H. Berger, George M. Fuhrman. The M.D. Anderson Surgical
Oncology Handbook ( 2006 ).
2.
Daniel G. Deschler,Md , Terry Day, MD . TNM staging of head and neck cancer and
neck dissection classification ; pocket guide to ( 2008 ).
3.
Eray Copcu and Alper Aktas. Simultaneous two organ metastases of the giant basal cell
carcinoma of the skin : A case report ( 2005 )
4.
Feriyl Bhaijee, Yuri E. Nikiforov. Molecular analysis of thyroid tumors ( 2011 ).
5.
Graeme J Poston, R Daniel Beauchamp, Theo JM Ruers. Textbook of surgical oncology
( 2007 ).
6.
Hossein Gharib, MD,MACP,MACE et all.
American association of clinical
endocrinologists and associazione medici endocrinologi medical guidelines for clinical
practice for the diagnosis and management of thyroid nodules ( 2006 ).
7.
Keyvan Nouri. Skin cancer ( 2008 ).
8.
Yuki Saito, Iwao Sugitani, Kazuhisa Toda, Keiko Yamada, Yoshihide Fujimoto .
Metastatic thyroid tumors : ultrasonographic features, prognostic factors and outcomes in
29 cases ( 2012 ).
11
2
3
4
5
Basal Cell Carcinoma and Thyroid Tumor ( Two Primary Tumors )
in Female 74 Years Old : A Case Report
I Kt Wisudana Yuana 1, IB Made Suryawisesa, Pt Anda Tusta A, Gede Budhi Setiawan,
Kt Widiana, Wyn Sudarsa, INW Steven Christian, IB Tjakra Wibawa M 2
1 Resident of General Surgery , Faculty of Medicine,Udayana University –
Sanglah General Hospital Denpasar
2 Sub Division of Oncology Surgery, Faculty of Medicine, Udayana University –
Sanglah General Hospital Denpasar
Introduction
Basal cell carcinoma (BCC) is the most non melanoma skin cancer in humans. It
accounts for 20% of carcinomas in men and 10–15% of carcinomas in women. Approximately
75–86% of primary BCCs are found on the head or neck. The most common location on the head
is the nose, specifically the nasal tip and alae. Sun exposure is the primary etiologic agent for the
development of BCC.1,3,7
Thyroid tumor can be a benign tumor such as thyroid adenoma, or it can be a malignant
neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer.
Most patients are 25 to 65 years of age when first diagnosed, women are more affected than men.
Thyroid cancer is the most common endocrine malignancy, and its incidence is rising in the USA
and other countries. Papillary and follicular thyroid carcinomas are the two most common types
of thyroid cancer.3,4,5,8
Despite its high incidence, Basal cell carcinoma and thyroid tumor events are
exceedingly rare in one patient.3,8
6
Case
A seventy four years old woman came to Sanglah Hospital with chief complain of tumor
on the right inferior palpebra and neck since 2 years ago. On physical examination, 3 cm firm,
tender, dark mass on the right inferior palpebra and on the left neck, thyroid mass was palpated
18 cm firm,tender ( Figure 1 ). There was no familial history of multiple tumors or cysts. History
of medicine unknown.
A computed tomography (CT) scan of the neck showed an 8-9 cm mass in the left lobe of
the thyroid gland, push the oropharynk to the right side, infiltrated m. longus colli and the left
m.sternocleidomastoid, and adhere on the left v.jugularis externa and interna ( Figure 2 ). Fine
needle aspiration (FNA) of the left thyroid gland then revealed a cytological interpretation of
suspicious for papillary carcinoma. And FNA of the right inferior palpebra interpretation of
basal cell carcinoma (BCC).
Figure 1. Tumor on the right inferior palpebra and left neck since 2 years ago.
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Figure 2. A computed tomography (CT) scan of the neck showed an 8-9 cm mass in the
left lobe of the thyroid gland
Discussion
Basal cell carcinoma (BCC) is the most common carcinoma in humans and accounts for
20% of carcinomas in men and 10–15% of carcinomas in women. Approximately 75–86% of
primary BCCs are found on the head or neck. The most common location on the head is the nose,
specifically the nasal tip and alae. It constitutes 90% of periorbital malignancies. Sun exposure is
the primary etiologic agent for the development of BCC. BCC arising on the medial canthus tends
to be deep and invasive and may result in perineural extension and loss of optic nerve function.
Pieh et al reported that the highest recurrence rates of BCC following attempted excision,
(approximately 60%), was seen with lesions arising from the medial canthus since these lesions
8
tend to be more invasive and difficult to manage. Reclusive patients or patients who neglect the
lesions for long periods of time are more likely to have giant, invasive tumors. Giant BCC,
defined as lesions more than 5 cm at its largest diameter, are rare forms of BCC. Giant BCCs
more commonly appear on the trunk and display a more aggressive behavior, resulting in local
invasion and metastasis. The reported incidence of metastatic BCC ranges from 0.03 % to 0.55 ,
the most metastatic location are lung and parotid gland.1,3,5,7
Thyroid tumor can be a benign tumor such as thyroid adenoma, or it can be a malignant
neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer.
Most patients are 25 to 65 years of age when first diagnosed; women are more affected than
men. Thyroid cancer is the most common endocrine malignancy, and its incidence is rising in
the USA and other countries. Papillary and follicular thyroid carcinomas are the two most
common types of thyroid cancer.2,3,4,5,6
The patient then underwent a left isthmolobectomy and right excision basal cell
carcinoma and
reconstruction with cheek flap advancement ( Figure 3). Pathological
examination of the thyroid gland demonstrated cuboid epitel cell, Hurtle cell, cystic follicle with
variably-sized follicles, but no evidence of carcinoma. Sections of the right inferior palpebra
excision showed nodular basal cell carcinoma.The carcinoma was characterized by irregularly
shaped aggregates, nests and cords of basaloid cells with peripheral palisading and a variable
intervening fibrotic stroma.
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Figure 3. The patient underwent a left isthmolobectomy and right excision basal cell
carcinoma and reconstruction with cheek flap advancement.
Conclusion
Two primary tumors in one patient is a rare case, and we must carefully and differentiated
with the metastatic primary tumor. We can prove by the pathological examination, because the
other diagnostic maybe wrong.1,3,8
10
References
1.
Barry W.Feig, David H. Berger, George M. Fuhrman. The M.D. Anderson Surgical
Oncology Handbook ( 2006 ).
2.
Daniel G. Deschler,Md , Terry Day, MD . TNM staging of head and neck cancer and
neck dissection classification ; pocket guide to ( 2008 ).
3.
Eray Copcu and Alper Aktas. Simultaneous two organ metastases of the giant basal cell
carcinoma of the skin : A case report ( 2005 )
4.
Feriyl Bhaijee, Yuri E. Nikiforov. Molecular analysis of thyroid tumors ( 2011 ).
5.
Graeme J Poston, R Daniel Beauchamp, Theo JM Ruers. Textbook of surgical oncology
( 2007 ).
6.
Hossein Gharib, MD,MACP,MACE et all.
American association of clinical
endocrinologists and associazione medici endocrinologi medical guidelines for clinical
practice for the diagnosis and management of thyroid nodules ( 2006 ).
7.
Keyvan Nouri. Skin cancer ( 2008 ).
8.
Yuki Saito, Iwao Sugitani, Kazuhisa Toda, Keiko Yamada, Yoshihide Fujimoto .
Metastatic thyroid tumors : ultrasonographic features, prognostic factors and outcomes in
29 cases ( 2012 ).
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