Oh, the Wonders of Thyroid Cancer’s Travel Itinerary

Once upon a time, a sprightly 60-year-old lady waltzed into our clinic, her right ankle singing a tune of pain that had been on the charts for a whopping three months. But wait, there’s a twist! This wasn’t just any old ankle pain; this was the grand reveal of a thyroid cancer world tour, post-total thyroidectomy and a neck dissection that sounds more like a dance move than a medical procedure.

After a cozy radioactive iodine (131I) spa treatment, our patient’s cancer decided to leave some souvenirs in the thyroid region, because why not? But hold your applause, because the SPECT/CT and FDG-PET CT scans were like a game of hide and seek with mediastinal lymph nodes and bone lesions playing hard to get.

Enter the ankle X-ray and MRI, showcasing a lytic lesion in the calcaneus with a soft tissue mass that was probably just trying to fit in. And, surprise! The histopathology after-party confirmed thyroid cancer had crashed the calcaneus, an oh-so-rare venue for such events.

But wait, there’s more! Our cancer brought friends: HRAS and GNA13 gene mutations, and a high tumor mutational burden that screams, “I’m ready for my close-up, Mr. Immune Checkpoint Inhibitor!”

So, what have we learned? Poorly differentiated thyroid carcinoma (PDTC) doesn’t just settle for the lungs and bones; it goes for the gold with the calcaneus. And if you’re a distant metastasis, your long-term prognosis is looking about as bright as a Game of Thrones character’s. But fear not, radiotherapy’s here to zap away the pain and shrink those pesky metastases. And let’s not forget our MVP, PAX-8 staining, for telling thyroid and lung cancers apart.

In conclusion, when thyroid cancer decides to go on a metastatic holiday, it’s not just about the destination; it’s about the journey… and the gene mutations that could score you a ticket to the latest in PDTC treatment trends. Bravo, science, bravo.