Online First

2021 : Volume 1, Issue 1

Incidental Findings Revealed During COVID-19 Pandemic: Thyroid Papillary Carcinoma and Suspected Rib Chondrosarcoma

Author(s) : Sevket Kahraman ¹ , Oguz Lafci ² , Ozlem Kadirhan ¹ , Sonay Aydin ¹ and Erdal Karavas ¹

¹ Department of Radiology , Erzincan University , Turkey

² Department of Radiology , Ankara Training and Research Hospital Emergency , Turkey

J Nucl Med Imaging

Article Type : Case Reports

Abstract

Chest CT imaging has been done widely for the diagnosis of COVID-19 patients during the pandemic. Simultaneously diagnosis of thyroid malignancy and chondrosarcoma was found incidentally in a patient presenting with symptoms of coronavirus. We presented the coexistence of thyroid papillary carcinoma and chondrosarcoma, which are rare in literature, in the patient who did not have a history of radioactive iodine treatment before.

Keywords: Chondrosarcoma; Thyroid Papillary Carcinoma; COVID-19, Incidental; CT

Introduction

Chest CT imaging has been done widely for the diagnosis of COVID-19 patients during the pandemic. Although COVID-19 cases detected during evaluations for other indications have been reported [1,2], there is not enough data on cancers detected incidentally during COVID-19 screening. Here we report a case of a 57-year-old woman who was diagnosed with metastatic thyroid papillary carcinoma and suspected chondrosarcoma of the rib after a non-contrast chest CT scan for COVID-19 evaluation.

The Coronavirus Disease 2019 (COVID-19) pandemic has affected many aspects of the health system including the oncology practice. In the USA shutdowns related to COVID-19will result in the estimated delay of more than 22 million screening tests for cancer and a 20% reduction in oncology visits [3].

Case Report

A 57-year-old woman who had a fever, joint ache, and difficulty in breathing referred to our emergency clinic. A non-enhanced thorax ct san was done to rule out possible COVID-19 pneumonia according to the proposed diagnostic algorithm at the time of the referral. There were peripherally located patchy ground-glass opacities at both lungs [Figure 1]. Those infiltrations highly suggested COVID-19 infection which was later confirmed by reverse transcriptase polymerase chain reaction (RT-PCR). Additionally, it was recognized that the thyroid gland was enlarged and reaching the retrosternal area. There were also nodules with calcifications in the gland and the parenchyme was heterogeneous [Figure 2]. Furthermore, there was a 3x2 cm measured, heterogeneous lytic expansile lesion with sclerotic margins that composed of chondroid matrix located at the lateral aspect of the 9th rib. Also, the lesion was leaning on the liver. There were hypodense liver lesions which were later proved to be cysts [Figure 3]. The patient diagnosed with thyroid papillary carcinoma by fine-needle aspiration biopsy. Also, fine needle aspiration biopsy (FNAB) confirmed metastasis to the lymphadenopathies that were suspected at US imaging.

Figure 1: Axial CT image, shows peripherally located patchy ground-glass opacities.

Figure 2: A-axial CT image, B-coronal CT image: Thyroid gland has enlarged and reached the retrosternal region. Calcified nodules were also present in the gland, and the parenchyma is heterogeneous (within the white circle).

Figure 3: A: CT image in the axial bone window shows a sclerotic margined, heterogeneous lytic expansile lesion consisting of a chondroid matrix located medial to the rib (black arrow); B: CT image in the axial parenchyma window, shows nonspecific hypodense lesions in the left lobe of the liver (black arrow).

To evaluate the progression of the costal lesion previous chest X-rays of the patient were reviewed. It was understood that the lesion was stable by comparing the 2018 and 2020 dated X-rays. Based on the presence of the chondroid matrix, irregular cortex reaction; it was postulated that the lesion was chondrosarcoma. Unfortunately, a rib resection couldn’t be done immediately because of the conditions caused by COVID-19.

Discussion

In this report, we presented a rare coexistence: chondrosarcoma and thyroid papillary carcinoma, diagnosed incidentally by a CT scan performed for COVID-19 pneumonia.

The COVID-19 pandemic and related stay-at-home orders estabilished across the country limited patient access to the healthcare system. Unintended consequences of the COVID-19 pandemic may include long-term implications on oncology patients who missed cancer screenings and surgeries during this period. An analysis of 20 healthcare institutions part of the COVID and Cancer Research Network reported decreases in cancer encounters by 40%-50% for lung, colorectal, hematologic, breast, and prostate cancers as well as melanoma [4]. The United Kingdom recently estimated that delays in diagnosis and treatment may increase mortality from breast, colorectal, and lung cancers by as much as 9.6%, 16.6%, and 5.3%, respectively, after 5 years [5].

Recent publications mainly focused on incidentally diagnosed COVID-19 patients by imaging [1,2] or affects of COVID-19 pandemic on cancer screening [6,7].

In Brasil, one of the most affected countries from COVID-19, it is reported that demand for chest CT increased around 192% to 1000% between 1st of March and 30th of June when compared to 2019 [8].

According to a retrospective study among 13,810 cancer patients, the incidentally diagnosed cancer rate was 4% (n=520) and 12% of them were thyroid malignancies [9].

The presented case can add to the literature with also another different aspect; in the literature papillary throid cancer was associated with renal cell carcinoma, invasive breast carcinoma, chondroid tumors, benign ganglioneuroma and colon adenomas. Chondroid tumors are related with radioiodine theraphy for thyroid cancers. As far as we know previosly no similar association was reported for simultaneously diagnosis of papillary throid cancer and condroid tumors [10].

It can be expected that there will be an increase in cancers detected incidentally due to the increased usage of chest CT during COVID-19 pandemic. There is not sufficient data on incidentally diagnosed cancer rates by diagnostic imaging neither from the pre-pandemic period nor the COVID-19 era.

As presented in our case, it is possible that some people without any related symptoms could have been diagnosed with cancer incidentally by imaging for the COVID-19 infection.

Conclusion

Incidentally diagnosed cancer is a known entity, however; the effect of excessive imaging for COVID-19 pneumonia on incidentally diagnosed cancer rates is still unknown. Incidental cancers should be taken into account in studies that investigate the effects of the COVID-19 pandemic on oncology practice.

References

Ali SA, Abdelkawi MM. Incidentally Recognized COVID-19 Pneumonia in Routine Oncologic ¹⁸F-FDG PET/CT Examinations: A Local Experience During Pandemic Era. Egypt J Radiol Nucl Med. 2020;51:1-10.
Neveu S, Saab I, Dangeard S, et al. Incidental Diagnosis of Covid-19 Pneumonia on Chest Computed Tomography. Diagn Interv Imaging. 2020;101:457-461.
The Lancet O. COVID-19 and The US Health Insurance Conundrum. Lancet Oncol. 2020;21:733.
London JW, Fazio-Eynullayeva E, Palchuk MB, et al. Effects of The COVID-19 Pandemic on Cancer-Related Patient Encounters. JCO Clinical Cancer Informatics. 2020;4:657-665.
Maringe C, Spicer J, Morris M, et al. The Impact of the COVID-19 Pandemic on Cancer Deaths Due to Delays in Diagnosis in England, UK: A National, Population-Based, Modelling Study. The Lancet Oncology. 2020;21:1023-1034.
Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors. JCO Clin Cancer Inform. 2020;4:1059-1071.
Broom A, Kenny K, Page A, et al. The Paradoxical Effects of COVID-19 on Cancer Care: Current Context and Potential Lasting Impacts. Clin Cancer Res. 2020;26:5809-5813.
Vicente CR, Sant'Ana MCS, Reis AP, et al. Increasing Demand for Chest CT Due to COVID-19 in Brazil. Revista da Sociedade Brasileira de Medicina Tropical. 2020;53.
Koo MM, Rubin G, McPhail S, et al. Incidentally Diagnosed Cancer And Commonly Preceding Clinical Scenarios: A Cross-Sectional Descriptive Analysis of English Audit Data. BMJ Open. 2019;9:e028362.
Atta IS, AlQahtani FN. Thyroid, Renal, and Breast Carcinomas, Chondrosarcoma, Colon Adenomas, and Ganglioneuroma: A New Cancer Syndrome, Fap, or Just Coincidence. Case Rep Med. 2016;2016.

Correspondence & Copyright

Corresponding Author: Dr. Sonay Aydin, Department of Radiology, Erzincan University, Erzincan, Turkey.

Copyright: © 2021 All copyrights are reserved by Sonay Aydin, published by Coalesce Research Group. This work is licensed 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.