Skull Metastasis From Thyroid Follicular Carcinoma With Difficult Diagnosis of the Primary Lesion-Case Report-

Abstract

A 57-year-old male patient presented with an immobile ellipsoid mass of 6-cm diameter in the right occipitoparietal region. Cranial computed tomography showed the mass with dense contrast enhancement causing bone destruction. After embolization of the mass, total resection was performed. Histological examination showed the mass had a capsule, with no invasion of the dura mater or dermis, and the follicles of various sizes covered with mono-lined thyrocytes were full of colloid. Immunohistochemical examination showed positive staining for thyroglobulin. Postoperatively, levels of thyroid hormones were normal, and thyroid ultrasonography and technetium-99m scintigraphy showed no abnormalities. Fine needle aspiration biopsy performed at various locations of the thyroid gland revealed no atypical thyroid cells. Whole body technetium-99m scintigraphy found no abnormal bone involvement. The histological evidence was suggestive of follicular carcinoma metastasis. Surgical treatment was planned for the thyroid gland, but the patient did not consent. Two years later, the patient presented with the pain and sensitivity in the sacrum, the right iliac wing, and the right caput femoris. Computed tomography revealed lytic lesions in these areas. Bone metastases were identified. Whole body scintigraphy showed increased activity in these regions, but the cranium and all other tissues were normal. The patient underwent total thyroidectomy under a diagnosis of follicular carcinoma. The present case of a lytic skull lesion associated with normal thyroid tissue on admission but finally treated as follicular thyroid cancer emphasizes the difficulty in histological discrimination of follicular carcinoma from normal thyroid tissue.

Skull metastasis in papillary carcinoma of thyroid: A case report

“…Skull is a rare site for metastases, which when they occur, are most commonly located in the occipital region presenting as a soft, painless lump [1,16] . These lesions are osteolytic on skull X-ray and CT scan and highly vascular on angiographic assessment [1,17] . Prognosis in the case of metastasis is generally poor and the 10-year survival with bone metastasis from differentiated thyroid cancers is reported to be 27% [2] .…”

A rare case of solitary subcutaneous scalp metastasis from follicular thyroid carcinoma revealed with positron emission tomography/computed tomography: A case report and review

“…[1] Scalp is an uncommon site for metastasis and which is extremely rare. [2] Metastatic tumors to the scalp are most often from lung, breast, and prostate malignancies and rarely from thyroid cancers. [3] In this case, a 49-year-old patient with solitary scalp metastasis from follicular thyroid cancer was presented.…”

Skull Base Metastasis From Follicular Thyroid Carcinoma -Two Case Reports-

“…The lung is the most common metastatic site for thyroid carcinoma followed by the bone, 7,10,26,27) but skull metastasis of thyroid carcinoma is rare, with few reported cases. [1][2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]25,26,[28][29][30][31][32][33][34][35][36][37][38]40,41,44,45) The largest series of skull metastasis from thyroid carcinoma reported a frequency of only 2.5% among 473 patients. 26) Moreover, skull base metastasis from differentiated thyroid carcinoma is even rarer, with only 23 reported cases, including 17 cases of skull base metastasis from FTC that involved the clivus, cavernous sinus, sella turcica, petrous apex, and petrous ridge.…”