Kanchan P Dholam1, Gurkaran Preet Singh1*, Sandeep V Gurav1Bharat Bharat Rekhi2
1Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Mumbai, India
2Department of Pathology, Tata Memorial Hospital, Mumbai, India
Received: 21 December, 2016; Accepted: 03 January, 2017; Published: 04 January, 2017
Dr. Gurkaran Preet Singh, Fellow, Department of Dental & Prosthetic Surgery, Tata Memorial Hospital, Mumbai, Tel: +91 9417424201; E-mail:
Dholam KP, Singh GP, Gurav SV, Rekhi BB (2017) Rare Late Mandibular Metastasis in Follicular Variant of Papillary Carcinoma Thyroid: ‘Resurgence of the Sleeping Tumour’. Arch Otolaryngol Rhinol 3(1): 001-05. DOI: 10.17352/2455-1759.000032
© 2017 Dholam KP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Mandible; Thyroid; Follicular variant; Metastasis; Follow-up
Cancer of the thyroid gland is the most common endocrine malignancy constituting for less than 1% of all reported human cancers1. The propensity of occurrence of thyroid carcinomas is two to four times more in females as compared to males with a median age at diagnosis being 45–50 years [1,2]. Papillary thyroid carcinoma (PTC) is the most common histological type of thyroid cancer and accounts for more than 80 % of thyroid malignancies. Classical PTC (cPTC) is the most common (80%) sub-type of papillary thyroid carcinoma followed by follicular variant (FVPTC) which is found in 9–22.5% of patients .
FVPTC was first described by Crile and Hazard in 1953 as alveolar variant of PTC. It was subsequently confirmed by Lindsay, Chen and Rosai as an independent entity with typical nuclear features and follicular growth pattern. FVPTC further has histological variants namely, completely encapsulated form, well circumscribed form, and infiltrative form, the last being the most aggressive [2,4]. The encapsulated variant is relatively more prevalent than the other sub-type and is non-aggressive in nature. In order to distinguish it from the invasive variant, histologically, it has been renamed as ‘noninvasive follicular thyroid neoplasm with papillary-like nuclear features’.
Invasive follicular variant of PTC presents several diagnostic and management challenges . Late metastasis to the mandible is extremely rare and could be the only sign of a silent underlying neoplasm. Such lesions may resemble odontogenic lesions and should be carefully differentiated from them. This case report is a description of rare late mandibular metastases in a previously diagnosed case of invasive follicular variant of papillary carcinoma thyroid. It reiterates the significance of vigilant screening during follow-up visit so as not to miss timely diagnosis.
A 58 year old lady reported with a persistent soft, non-tender swelling of 1 month duration over the left side of her face. The swelling was sudden in onset and there was no associated paresthesia reported.
On extra oral examination, a solitary, oval diffuse swelling was observed over the left side of face measuring 5 x 6 cms over left ramus of the mandible (Figure 1a). It was palpable deep to the masseter extending from the pre-auricular region to the angle of the mandible inferiorly.
Intra-oral examination revealed hypertrophic tissue in the left retro-molar trigone area with no other associated abnormality (Figure 1b). There was no tooth mobility or any evidence of ulcero-proliferative growth seen. The patient gave no history of recent extraction or spontaneous exfoliation of any tooth.