Synchronous metastasis from double primary cancers in a single left supraclavicular lymph node

A 39-year-old woman was referred to our hospital for invasive cervical cancer. On initial physical examination, inguinal lymph nodes, but not supraclavicular lymph nodes, were palpable. Positron emission tomography revealed multiple bone metastasis with hypermetabolic lymph nodes in the abdominal and pelvic cavity, left supraclavicular fossa, and a mild hypermetabolic nodular lesion in the left thyroid (Fig. 1A). Gun biopsy was performed for the left supraclavicular lymph node. Ultrasonography indicated the left thyroid nodule was a 1 cm sized hypoechoic lesion with inner calcification (Fig. 1B). Papillary thyroid carcinoma was diagnosed with fine needle aspiration (Fig. 1C). A lymph node specimen revealed synchronous metastasis from a double primary origin (Fig. 2A, ×40). One metastatic lesion (Fig. 2B, blue square, ×100) showed papillary growth and was positive for thyroglobulin immunohistochemical stain (Fig. 2C, ×100), consistent with thyroid carcinoma. Another metastatic lesion (Fig. 2D, yellow square, ×100) was negative for thyroglobulin (Fig. 2E, ×100). Immunohistochemical staining was positive for p16 (Fig. 2F, ×100) and p63 (Fig. 2G, ×100), verifying metastatic squamous cell carcinoma. Final diagnosis was advanced cervical cancer (stage IVb), and she re1Department of Internal Medicine, Seoul National University College of Medicine, Seoul; 2Department of Internal Medicine, Veterans Health Service Medical Center, Seoul; 3Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul; 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea