Unusual presentation of follicular thyroidcarcinomaas mandibular metastasis

Abstract

………………………………………………………………………………………………………………………............... Abstract Primary carcinoma of thyroid presenting as mandibular metastasis is a rare incidence. Most of the time patient presents with various other symptoms due to hematogenous spread of primary neoplasm. We are presenting a rare case where metastatic lesion of mandible was the presenting feature and the patient was then subsequently diagnosed to have primary follicular carcinoma of thyroid. primary thyroid malignancy with mandibular and calvarial metastases was raised. Sub sequently ultrasound of left mandibular region revealed large soft tissue mass lesion with increased vascularity on colour Doppler. Ultrasound of thyroid revealed bulky left lobe having heterogeneous echotexture and scattered macro calcifications. No significant cervical lymphadenopathy was seen. X ray skull lateral view also revealed lytic lesion in occipital region. Ultrasound guided Fine needle aspiration cytology (FNAC) was performed from left mandibular lesion as well as lesion in left lobe of thyroid. Microscopic examination revealed features offollicular thyroid carcinoma (FTC) at both sites consistent with primary FTC with metastatic mandibular lesion. FNAC revealed - moderate cellularity with large number of follicular epithelial cells present predominantly in micro-follicles, few in large groups and crowded in syncitial sheets, few follicular cells show intra nuclear inclusion. Moderate degree of anisonucleosis, prominence of nuclei and irregularity of nuclear margin suggestive of follicular metastasis to the mandible and follicular carcinoma from left lobe of thyroid