Background: Follicular carcinomas occur frequently in women beyond the 5th decade of life as a slow-growing thyroid nodule. They are known to invade locally and metastasize distantly. Common sites for distant metastases are lungs and bones. The bones often involved are axial skeleton such as vertebrae, sternum, and skull. Metastasis to scapula is an infrequent presentation and skeletal muscle metastasis is extremely rare. Methods: Case Report Results: We present a case of metastatic follicular thyroid carcinoma that manifested as a large scapular mass on the right shoulder of a 65-year-old female patient. MRI of the right shoulder revealed a large lobulated mass with central necrosis and non-delineation of the 4 rotator cuff muscles. Biopsy of the scapular mass revealed an invasive metastatic follicular carcinoma. A thyroid ultrasound showed a significant right thyroid nodule. The patient underwent total thyroidectomy and subsequent right total scapulectomy with biceps tendon transplantation attached to the clavicle. Histopathologic reports from both operations are consistent with invasive follicular thyroid carcinoma. The patient underwent radioiodine therapy. Follow-up showed no evidence of any functioning metastasis. Conclusion Soft tissue metastasis is an uncommon initial presentation of follicular thyroid carcinoma. Synchronous metastasis to the bone and soft tissue particularly on the right scapula and surrounding muscles is a rare occurrence that warrants this report.
Thyroid Neoplasms