There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.

Although up to 24% of metastatic cancers have been reported to spread to the thyroid gland, metastases to the thyroid are not detected in clinical practice in most cases. The prognosis is poor when metastatic cancer to the thyroid occurs. The aim of this study was to examine the clinical presentation, cytopathological findings, and clinical course of secondary cancers of the thyroid. The medical records of a total of 1013 histopathologically verified thyroid cancer patients treated during the period from January 1977 to December 1995 in Chang Gung Medical Center in Linkou were analyzed retrospectively. There were 14 patients (1.4% of all thyroid cancers) with secondary cancers of the thyroid with a mean age of 55.3 +/- 16.7 years. All these patients underwent thyroid ultrasonography and a fine-needle aspiration cytology of the thyroid (FNAC) before biopsy or surgical treatment. Tissue diagnosis was obtained by biopsy or necropsy in 12 or by thyroidectomy specimens in 2 patients. Most of the patients died within 9 months of diagnosis except for 2 patients who were lost to follow-up after transferring to another hospital and 1 patient with lymphoma. Before the surgical diagnosis, there were only 7 patients who metastatic neoplasms to the thyroid gland were diagnosed by FNAC. Anaplastic thyroid carcinoma was diagnosed in 5 patients. Benign nodule was diagnosed in 1 patient and lymphoma in another patient. Most of these patients had widespread metastases to many organs, as well as the thyroid gland. As a result these patients had very short survival times. Delayed diagnosis of the thyroid metastasis was the main reason for the short survival period. In conclusion, most of the metastatic lesions presented as an advanced stage of primary cancers. FNAC was a useful tool in the diagnosis. Histopathological diagnosis by surgical open biopsy is needed for the final diagnosis.

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We report the MRI and CT findings of an intracranial meningeal melanocytoma (IMM) arising from Meckel's cave and review the imaging characteristics of IMM. On CT, IMM constantly appear as well-circumscribed, isodense to slightly dense, extra-axial tumours with homogeneous contrast enhancement. This appearance is non-specific and similar to that of meningiomas or small neuromas. On MRI, the signal of IMM is strongly related to the amount of melanin pigment: the more melanin, the more shortening of T1 and T2 relaxation times. Only when it shows as a homogeneous mass, bright on T1 and dark on T2 weighting, can a specific diagnosis of a melanin-containing tumour be made. However, this still cannot provide a distinction between IMM and malignant meningeal melanoma.

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