mercaptopurine and Thyroid-Neoplasms

Clinically diagnosed metastasis to the thyroid gland is exceptionally rare and may present diagnostic issues on fine needle aspiration. The most common primary sites of metastases to the thyroid are cancers of the lung, breast, skin (especially melanoma), colon, and kidney. Herein, we report a case of metastatic Merkel cell carcinoma to the thyroid presenting as a 2.1-cm solid nodule in a 50-year-old male with a previous history of Merkel cell carcinoma of the upper extremity. The aspirates were moderately to highly cellular featuring small to intermediate sized cells with scant to no cytoplasm, round-to-oval nuclei with finely dispersed chromatin, and predominantly arranged as scattered single cells. There was focal nuclear molding, numerous mitoses, and karyorrhectic nuclei. The differential diagnosis centered on the "small round blue cell" tumor group such as medullary thyroid carcinoma and non-Hodgkin lymphoma. However, in light of our patient's previous history, the FNA findings were most consistent with a metastasis of Merkel cell carcinoma. In patients with a known history of a primary neoplasm, the differential diagnosis of a thyroid nodule should always include potential metastasis.

Topics: Biopsy, Fine-Needle; Carcinoma, Merkel Cell; Carcinoma, Small Cell; Crohn Disease; Diagnosis, Differential; Fibrosis; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Skin Neoplasms; Thyroid Neoplasms

We report on the thyroid involvement with Langerhans cell histiocytosis (LCH) in a 3-year-old male. The patient presented with goiter and primary hypothyroidism. His goiter caused life-threatening airway obstruction. He developed locally invasive disease 4 years after his response to LCH therapy. LCH should be suspected as a cause of goiter and thyroidectomy is recommended.

Topics: Airway Obstruction; Carcinoma, Papillary; Child, Preschool; Combined Modality Therapy; Goiter; Histiocytosis, Langerhans-Cell; Humans; Hypothyroidism; Male; Mercaptopurine; Methotrexate; Prednisone; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy; Thyroiditis, Autoimmune

A 29-year-old pregnant woman diagnosed with acute lymphocytic leukemia maintained remission with daily cyclophosphamide and intermittent prednisone treatment. She delivered a male twin with multiple congenital abnormalities who was diagnosed with papillary thyroid cancer at 11 years of age and stage III neuroblastoma at 14 years of age. The female twin was unaffected and has exhibited normal development to date. First trimester exposure to cyclophosphamide has been associated with major malformations. Metabolites of cyclophosphamide have been demonstrated to be teratogens and carcinogens in animals. Differences in placental or fetal hepatic cytochrome P-450 may account for the variability in response between the twins. In addition, disparity between the twins may be the result of differences in metabolite inactivating enzymes present either in fetal liver or placenta. The risk of second malignancies caused by alkylating agents such as cyclophosphamide has been well documented in adults and children but to the best of our knowledge this is the first description of transplacental second cancer.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Adrenal Gland Neoplasms; Adult; Aminopterin; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Papillary; Cyclophosphamide; Diseases in Twins; Female; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Mercaptopurine; Neuroblastoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Pregnancy; Pregnancy Complications, Neoplastic; Prenatal Exposure Delayed Effects; Thyroid Neoplasms; Time Factors; Twins, Dizygotic; Vincristine

Topics: Adolescent; Adult; Antineoplastic Agents; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Follow-Up Studies; Head and Neck Neoplasms; Hemangiosarcoma; Humans; Infant; Lung Neoplasms; Male; Mechlorethamine; Mercaptopurine; Methotrexate; Middle Aged; Neoplasm Metastasis; Pregnancy; Prostatic Neoplasms; Sarcoma; Teratoma; Testicular Neoplasms; Thoracic Neoplasms; Thyroid Neoplasms; Triaziquone; Uterine Neoplasms; Vinblastine

Topics: Cobalt Isotopes; Fibrosarcoma; Humans; Male; Mercaptopurine; Methods; Methotrexate; Neoplasm Recurrence, Local; Thyroid Neoplasms; Tomography; Tracheal Neoplasms