Context: Follicular carcinoma of the thyroid presenting as a distant metastases is rare. Case Report: We present a rare case of a 42 year old patient with follicular carcinoma of the thyroid who presented with pathological fracture of the tibia at the time of diagnosis. The cytological samples from the fracture site showed follicular neoplasm. Histopathological study of the resected thyroid specimen showed a tumor with capsule and vascular invasion. Conclusions: The present case emphasizes that it is unusual for this neoplasm to initially present as distant metastases, although metastases in the late stages of the disease is more common presentation. Thyroid follicular carcinoma should be included in the differential diagnosis in cases of extrinsic tumoral lesions. Introduction Follicular thyroid carcinoma is the second most common thyroid cancer and is a slow growing tumor1. It accounts for 10-20% of all thyroid malignancies2. The lesion tends to occur in older age groups, with a peak incidence in the fifth decade. It is three times more common in females than in males. The tumor usually presents as an asymptomatic solitary intra-thyroid nodule. These neoplasms tend to metastasize hematogeneously, with lung and bone most commonly affected1,2. The incidence of distant metastasis of follicular thyroid carcinoma has been reported as between 11 and 25%3,4,5. However, Follicular thyroid cancer presenting with metastases as intial presentation is very rare. We report and discuss the unusual presentation of this case. Case Report A 42-year old female, presented with fracture tibia (left) after a trivial trauma. Radiological studies were suggestive of a pathological fracture (Image 1). The patient was examined for general survey and health. On general physical examination, she appeared to be in mild distress, poorly built and nourished. The vital signs were stable. The systemic examination was apparently normal. Examination of the neck revealed prominent right lobe thyroid.
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