Metastatic thyroid tumor (MTT) refers to a secondary thyroid malignancy originating from other organ cancers through hematogenous spread, lymphatic dissemination, or direct invasion. Common primary tumors include renal cell carcinoma, lung cancer, breast cancer, gastrointestinal malignancies, and melanoma. Clinical manifestations of MTT lack specificity, often mimicking primary thyroid carcinoma, with presentations such as thyroid nodules or cervical masses. Hematogenous spread is the most frequent metastatic route, followed by lymphatic spread and direct invasion. At the molecular level, alterations such as BRAF, KRAS, and EML4-ALK mutations and signaling pathway abnormalities are implicated. Diagnosis relies on imaging, fine-needle aspiration (FNA), and immunohistochemical markers. Thyroglobulin (Tg), thyroid transcription factor-1 (TTF-1), carbonic anhydrase Ⅸ (CAⅨ), Napsin A, PAX8, GATA3, and S-100 are valuable in differentiating primary from metastatic tumors. Treatment strategies depend on the type of primary tumor and the extent of metastasis. Surgery can improve local control and relieve compressive symptoms, while resection of isolated metastases combined with treatment of the primary lesion may prolong survival. Systemic therapies include chemotherapy, radiotherapy, targeted therapy, and immunotherapy, with some patients benefiting from molecularly guided regimens. Prognosis varies substantially with the primary tumor: patients with renal cell carcinoma have relatively better survival, whereas those with lung cancer, gastrointestinal malignancies, or melanoma exhibit poorer outcomes. Overall, the management of MTT requires a multidisciplinary approach integrating pathology and molecular testing to achieve individualized therapy and improved patient survival.
Key words
thyroid metastases /
metastatic mechanisms /
imaging diagnosis /
fine-needle aspiration /
immunohistochemistry /
surgical treatment /
systemic therapy /
prognosis
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