{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:54Z","timestamp":1784557074541,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"\n Summary<\/jats:title>\n \n A 60-year-old woman presented to our clinic with an acute onset 3 months history of right ankle pain. The patient had a history of poorly differentiated thyroid cancer, which was treated with total thyroidectomy, left lateral neck dissection levels II\u2013V and central neck dissection levels VI\u2013VII followed by postoperative I-131 radioactive iodine (\n 131<\/jats:sup>\n I) ablation therapy 3.7 GBq 6 months ago. The post-\n 131<\/jats:sup>\n I WBS showed residual iodine-avid thyroid tissue with no other iodine-avid disease or metastasis. SPECT\/CT of the neck and chest showed nonavid bilateral pulmonary nodules, discrete nodal masses in mediastinum and nonavid bone lesions. FDG-PET CT scan showed FDG-avid mediastinal lymph nodes (LN), innumerable non-FDG-avid subcentimetric pulmonary nodules and few FDG-avid lytic lesions in the skeleton. X-ray and MRI of the right ankle showed a well-marginated lytic lesion in the posterior body of calcaneus and 5 \u00d7 6 cm soft tissue mass lesion, respectively. The histopathology of the calcaneus mass confirmed a positive immunostaining for thyroid origin which includes thyroglobulin and TTF-1 with PAX-8. Endobronchial mediastinal and bronchial LN biopsy confirmed thyroid cancer metastasis. Gene mutation showed HRAS and GNA13 with a high tumor mutational burden. We describe a rare case of poorly differentiated thyroid cancer in a patient who presented with right ankle pain; we confirmed the cause to be a calcaneus metastasis from the thyroid cancer, with calcaneus being an extremely rare site for bone metastases. Gene mutations points toward treatment with immune checkpoint inhibitors.\n <\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Poorly differentiated thyroid carcinoma (PDTC) usually metastasizes to lung and bone but can rarely occur in the calcaneus.<\/jats:p>\n <\/jats:list-item>\n \n Patients with distant metastases have significantly worse long-term prognosis.<\/jats:p>\n <\/jats:list-item>\n \n Radiotherapy is effective in reducing the metastatic pains as well as reducing the size of the metastasis.<\/jats:p>\n <\/jats:list-item>\n \n PAX-8 staining can be used to differentiate thyroid carcinomas from lung adenocarcinomas.<\/jats:p>\n <\/jats:list-item>\n \n The importance of searching for gene mutations to decide the treatment of PDTC.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-23-0103","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T07:30:28Z","timestamp":1701847828000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":2,"title":["Calcaneus metastasis: a rare presentation of poorly differentiated thyroid cancer"],"prefix":"10.1530","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0690-6527","authenticated-orcid":true,"given":"Omayma","family":"Elshafie","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Summit","family":"Bichpuria","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamina","family":"Rassou","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Furqan","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abir","family":"Bou Khalil","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"European Thyroid Journal","first-page":"e220021","article-title":"Poorly differentiated thyroid carcinoma: a clinician\u2019s perspective","volume":"11","author":"Tong","year":"2022","unstructured":"Tong JRuan MJin YFu HCheng LLuo QLiu ZLv Z & Chen L. 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Minia Journal of Medical Research202031141\u2013143. (https:\/\/doi.org\/10.21608\/mjmr.2022.217551)"},{"key":"bib4","series-title":"Journal of Bone Oncology","first-page":"100282","article-title":"Bone metastases in thyroid cancer","volume":"21","author":"I\u00f1iguez-Ariza","year":"2020","unstructured":"I\u00f1iguez-Ariza NMBible KC & Clarke BL. Bone metastases in thyroid cancer. Journal of Bone Oncology202021100282. (https:\/\/doi.org\/10.1016\/j.jbo.2020.100282)"},{"key":"bib5","series-title":"Journal of Endocrinological Investigation","first-page":"403","article-title":"Bone metastases from differentiated thyroid carcinoma: current knowledge and open issues","volume":"44","author":"Nervo","year":"2021","unstructured":"Nervo ARagni ARetta FGallo MPiovesan ALiberini VGatti MRicardi UDeandreis D & Arvat E. Bone metastases from differentiated thyroid carcinoma: current knowledge and open issues. Journal of Endocrinological Investigation202144403\u2013419. 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(https:\/\/doi.org\/10.3390\/cancers13174429)"},{"key":"bib8","series-title":"Pharmaceutics","first-page":"1040","article-title":"The role of the kinase inhibitors in thyroid cancers","volume":"14","author":"Cuomo","year":"2022","unstructured":"Cuomo FGiani C & Cobellis G. The role of the kinase inhibitors in thyroid cancers. Pharmaceutics2022141040. (https:\/\/doi.org\/10.3390\/pharmaceutics14051040)"},{"key":"bib9","series-title":"Frontiers in Endocrinology","first-page":"860671","article-title":"Target therapy in thyroid cancer: current challenge in clinical use of tyrosine kinase inhibitors and management of side effects","volume":"13","author":"Puliafito","year":"2022","unstructured":"Puliafito IEsposito FPrestifilippo AMarchisotta SSciacca DVitale MP & Giuffrida D. Target therapy in thyroid cancer: current challenge in clinical use of tyrosine kinase inhibitors and management of side effects. Frontiers in Endocrinology202213860671. (https:\/\/doi.org\/10.3389\/fendo.2022.860671)"},{"key":"bib10","series-title":"Cancer","first-page":"1195","article-title":"Efficacy and safety of pembrolizumab monotherapy in patients with advanced thyroid cancer in the phase 2 keynote\u2010158 study","volume":"129","author":"Oh","year":"2023","unstructured":"Oh DAlgazi ACapdevila JLongo FMiller WChun Bing JTBonilla CEChung HCGuren TKLin CC, Efficacy and safety of pembrolizumab monotherapy in patients with advanced thyroid cancer in the phase 2 keynote\u2010158 study. Cancer20231291195\u20131204. 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