Poorly differentiated thyroid carcinoma with sternal invasion. A case report and review of the literature

• Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction have been reported.
• We report a 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion who underwent total thyroidectomy and partial sternal resection and chest wall reconstruction.
• In previous case reports the sternal tumor was not in continuity with the thyroid tumor.
• Despite developing an early local recurrence, there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively.

INTRODUCTIONSurgical resection of poorly differentiated thyroid carcinoma with direct invasion of the sternum has not been previously reported. Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction for sternal metastases have been published.PRESENTATION OF CASEA 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion underwent total thyroidectomy and resection of the manubrium and both clavicular heads, and chest wall reconstruction with polypropylene mesh and bilateral myocutaneous pectoralis major muscle flaps. Postoperatively, the patient received radioactive iodine ablation. She developed a local recurrence, requiring additional ablation with radioactive iodine and external beam radiation therapy. Although there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively, a possible local recurrence was discovered 4 months later.DISCUSSIONIn previous case reports the sternal metastases were not in continuity with the thyroid tumor. In our patient, however, there was evidence of direct extension between the thyroid tumor and the sternal mass that were connected together with cords of tumor.CONCLUSIONIn our patient with poorly differentiated thyroid carcinoma invading the sternum, total thyroidectomy and resection of the manubrium with sternal reconstruction, combined with adjuvant radioactive iodine ablation and external beam radiation therapy was associated with prolonged survival after 5 years despite a small local recurrence.