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Kim H, Kim JH, Lee K, Kim TH. Incidentally-Discovered Extraosseous Cystic Nasopharyngeal Chordoma in a Papillary Thyroid Cancer Patient. JOURNAL OF RHINOLOGY 2019. [DOI: 10.18787/jr.2019.26.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hyunjung Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Jae Hyung Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Kijeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
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Dekker SE, Wasman J, Yoo KK, Alonso F, Tarr RW, Bambakidis NC, Rodriguez K. Clival Metastasis of a Duodenal Adenocarcinoma: A Case Report and Literature Review. World Neurosurg 2016; 100:62-68. [PMID: 28034818 DOI: 10.1016/j.wneu.2016.12.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clival metastases of adenocarcinomas are exceptionally rare tumors, especially when they arise from the small intestine. We present the first, to our knowledge, report of a metastasis of a duodenal adenocarcinoma to the clivus. We also present a systematic review detailing metastasis to the clivus. METHODS Studies were identified using the search terms "clival metastasis," "skull base metastasis," and "clivus" in PubMed. We collected the following information: histopathology of the primary tumor, symptoms, history, treatment, and follow-up. RESULTS A comprehensive review of the literature yielded 56 cases. Patients developed the first symptoms of clival metastasis at a mean age of 58 years. The most common primary neoplasms originated from the prostate, kidney, or liver. Most patients presented with an isolated sixth nerve palsy or diplopia. The time interval from diagnosis of the primary tumor to symptomatic presentation of clival metastasis ranged from 2 months to 33 years. Sixteen patients initially presented with symptoms of clival metastasis without a previously diagnosed primary tumor. Survival data were available for 35 patients, of which 63% died within a range of 2 days to 31 months after initial presentation. CONCLUSIONS Most primary neoplasms originated from the prostate, kidney, and liver, which differ from previous reports on skull base metastases. Abducens nerve palsy is often the first presentation of clival metastasis. Clival metastasis from duodenal carcinoma, although very rare, should be considered in the differential diagnosis of bony lesions of the clivus in a patient with a history of duodenal adenocarcinoma.
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Affiliation(s)
- Simone E Dekker
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
| | - Jay Wasman
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kevin K Yoo
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Fernando Alonso
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert W Tarr
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicholas C Bambakidis
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kenneth Rodriguez
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Matsuno A, Murakami M, Hoya K, M. Yamada S, Miyamoto S, Yamada S, Son JH, Nishido H, Ide F, Nagashima H, Sugaya M, Hirohata T, Mizutani A, Okinaga H, Ishii Y, Tahara S, Teramoto A, Osamura RY, Yamazaki K, Ishida Y. Clinicopathological and molecular histochemical review of skull base metastasis from differentiated thyroid carcinoma. Acta Histochem Cytochem 2013; 46:129-36. [PMID: 24194626 PMCID: PMC3813819 DOI: 10.1267/ahc.13019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/03/2013] [Indexed: 02/02/2023] Open
Abstract
Skull base metastasis from differentiated thyroid carcinoma including follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) is a rare clinical entity. Eighteen FTC cases and 10 PTC cases showing skull base metastasis have been reported. The most common symptom of skull base metastasis from FTC and PTC is cranial nerve dysfunction. Bone destruction and local invasion to the surrounding soft tissues are common on radiological imaging. Skull base metastases can be the initial clinical presentation of FTC and PTC in the presence of silent primary sites. The possibility of skull base metastasis from FTC and PTC should be considered in patients with the clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction. A variety of genetic alterations in thyroid tumors have been identified to have a fundamental role in their tumorigenesis. Molecular histochemical studies are useful for elucidating the histopathological features of thyroid carcinoma. Recent molecular findings may provide novel molecular-based treatment strategies for thyroid carcinoma.
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Affiliation(s)
- Akira Matsuno
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Mineko Murakami
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Katsumi Hoya
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Shoko M. Yamada
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Shinya Miyamoto
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - So Yamada
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Jae-Hyun Son
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Hajime Nishido
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Fuyuaki Ide
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | | | - Mutsumi Sugaya
- Department of Rehabilitation, Teikyo University Chiba Medical Center
| | - Toshio Hirohata
- Department of Neurosurgery, Teikyo University Chiba Medical Center
- Department of Neurosurgery, The University of Tokyo
| | - Akiko Mizutani
- Department of Neurosurgery, Teikyo University Chiba Medical Center
- Teikyo Heisei University
| | | | - Yudo Ishii
- Department of Neurosurgery, Nippon Medical School
| | | | | | - R. Yoshiyuki Osamura
- Department of Pathology, International University of Health and Welfare Mita Hospital
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center
| | - Yasuo Ishida
- Department of Pathology, Teikyo University Chiba Medical Center
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Deconde AS, Sanaiha Y, Suh JD, Bhuta S, Bergsneider M, Wang MB. Metastatic disease to the clivus mimicking clival chordomas. J Neurol Surg B Skull Base 2013; 74:292-9. [PMID: 24436927 DOI: 10.1055/s-0033-1348027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/15/2013] [Indexed: 12/14/2022] Open
Abstract
Objectives/Hypothesis A comprehensive review of the literature of clival metastases and presentation of two additional cases. Study Design Literature review and report of two cases. Methods A literature review of the MEDLINE database (1950 to January 19, 2013) was performed to identify all cases of patients with metastatic disease to the clivus. Additionally, two novel cases are presented. Results In total, 47 cases were identified in the literature, including the two cases presented in this study. Metastatic disease to the clivus is the initial presenting symptom of the primary malignancy in 36% (13/36) of the cases. When there was a history of malignancy, the median interval of time to clival metastases was 24 months (range 1 to 172 months). Clinical symptoms manifested often as cranial neuropathies, with at least abducens palsies as the initial presenting symptom in 61.9% (26/42) of patients. Tumor pathology was diverse, but several pathologies were seen more commonly: prostate carcinoma (18.1%, 9/47), hepatocellular carcinoma (10.6%, 5/47), and thyroid follicular carcinoma (8.5%, 4/47). Conclusion Although clival metastases are extremely rare, they are an important part of the differential of clival masses as they can be the presenting symptom of distant malignancy. Level of Evidence 4.
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Affiliation(s)
- Adam S Deconde
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yas Sanaiha
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sunita Bhuta
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Sako K, Kimura T, Sawamura A, Yonemasu Y, Takahashi M, Miyokawa N. Prevention of CSF Leakage by Staged Operation for Clival Metastatic Tumor. Skull Base Surg 2011; 7:159-62. [PMID: 17171026 PMCID: PMC1656631 DOI: 10.1055/s-2008-1058608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The transoral approach is a direct route to the clivus. However, application of this approach is infrequent because of the risk of cerebrospinal fluid (CSF) fistula and subsequent meningitis. We report a case of clival metastatic tumor treated by staged operation without CSF leakage. A 39-year-old man was found to have a tumor in clivus extending to the intradural space. Two-staged resection through the lateral suboccipital and transoral approach was performed and the dural defect was replaced by a fascia in the first operation. CSF leakage was prevented by this procedure. The patient received radiotherapy postoperatively.
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Matsuno A, Katakami H, Okazaki R, Yamada S, Sasaki M, Nakaguchi H, Yamada SM, Hoya K, Murakami M, Yamazaki K, Ishida Y, Iwasaki H, Kuyama J, Kakudo K. Skull base metastasis from follicular thyroid carcinoma -two case reports-. Neurol Med Chir (Tokyo) 2010; 50:421-5. [PMID: 20505304 DOI: 10.2176/nmc.50.421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 58-year-old woman and a 71-year-old woman presented with extremely rare skull base metastases from follicular thyroid carcinoma (FTC). Surgical removal and external radiotherapy were performed followed by iodine-131 ((131)I) brachytherapy and thyroid hormone administration. The metastatic tumors in the skull base were well controlled. Treatment for skull base metastasis from FTC includes surgical debulking of the metastatic lesion, as well as complete resection of the thyroid gland, followed by internal irradiation with (131)I, external irradiation, and administration of thyroid hormone to prevent tumor growth by suppression of endogenous thyroid-stimulating hormone. Skull base metastases may be the initial clinical presentation of FTC, with silent primary sites. The possibility of skull base metastasis from FTC should be considered in patients with clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction.
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Affiliation(s)
- Akira Matsuno
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
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Pallini R, Sabatino G, Doglietto F, Lauretti L, Fernandez E, Maira G. Clivus metastases: report of seven patients and literature review. Acta Neurochir (Wien) 2009; 151:291-6; discussion 296. [PMID: 19259614 DOI: 10.1007/s00701-009-0229-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tumours of the clivus are rare and metastases involving this area have been previously described only as single case reports or included in series with other skull base tumours. Here, we describe seven such examples and review the pertinent literature. METHOD Clinical, radiological and follow-up data of patients who had undergone surgery for clivus tumours at our Institution between January 1995 and December 2007 were retrospectively collected. A literature review was performed using PubMed. FINDINGS Of 46 patients who underwent surgery for clivus bone tumours, seven proved to harbour a metastasis. This figure represents 0.18% and 0.42% respectively of intracranial and skull base tumours which were treated in our Institution in the study period. The primary tumours associated were lung adenocarcinoma (n = 2), prostate carcinoma (n = 2), skin melanoma (n = 1), hepatocarcinoma (n = 1) and lung squamous cell carcinoma (n = 1). All patients presented with a sixth nerve palsy as the symptom. Histopathology was obtained via a trans-sphenoidal biopsy. In spite of radiotherapy and chemotherapy, the mean survival was 12 months. On literature review, 27 examples of metastases located in the clival bone were found. Including our series, the most common primary tumours were prostate cancer (26.4%), thyroid carcinoma (11.7%) and hepatocarcinoma (11.7%). CONCLUSION Though exceedingly rare, metastases involving the clivus should be considered in the differential diagnosis with clivus chordoma. The metastatic lesion might be a late and single expression of the primary tumour. The trans-sphenoidal approach is the ideal procedure to establish a histopathological diagnosis. Prognosis is poor.
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Solitary cranial metastasis of thyroid carcinoma 13 years after primary surgery: Report of a case. Surg Today 2009; 39:44-7. [DOI: 10.1007/s00595-008-3783-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 03/07/2008] [Indexed: 11/25/2022]
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Mydlarz WK, Wu J, Aygun N, Olivi A, Carey JP, Westra WH, Tufano RP. Management Considerations for Differentiated Thyroid Carcinoma Presenting as a Metastasis to the Skull Base. Laryngoscope 2007; 117:1146-52. [PMID: 17489069 DOI: 10.1097/mlg.0b013e318058192e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize the salient features of skull base metastasis from differentiated thyroid carcinoma, discuss the diagnostic and treatment strategies, and propose rational management guidelines for such tumors. STUDY DESIGN Case report. METHODS Review of English literature from MEDLINE with the addition of our case. RESULTS Skull base metastasis from differentiated thyroid carcinoma is rare, with only 20 cases reported to date, including our case report. On the basis of a review of all reported cases, both follicular and papillary thyroid cancers can metastasize to the skull base. Our case is unique because the lesion extends locally into the cavernous sinus and beyond. Histopathologic diagnosis is limited by the remote location of lesions. Most tumors are highly vascular, and there is potential for significant morbidity and mortality associated with surgical resection. The overall survival ranges from less than one year to 10+ years from the discovery of the metastasis and is similar in both tumor subtypes. There is no clear consensus on the management strategy for skull base metastasis from differentiated thyroid carcinoma. Interestingly, surgical resection of both the primary and metastatic lesions yields similar survival when compared with resection of the primary tumor alone. CONCLUSIONS Distant metastasis from differentiated thyroid carcinoma needs to be considered in the differential diagnosis of destructive skull base lesions, regardless of the patient's age. Histopathologic tissue diagnosis should always be attempted, followed by total thyroidectomy, radioiodine, or external beam radiation, and chronic thyroid-stimulating hormone suppression. Surgical resection of the metastatic lesion should only be performed in carefully selected cases because it is associated with significant morbidity.
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Affiliation(s)
- Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Abstract
The patient presenting with otalgia poses a diagnostic challenge for which orderly and diligent evaluation and management is needed. The etiology of otalgia can be either primary or referred, and a detailed history and physical examination with directed studies as indicated can elucidate the cause of the pain.
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Affiliation(s)
- Rahul K Shah
- Department of Otolaryngology-Head and Neck Surgery, Tufts University School of Medicine, New England Medical Center, 750 Washington Street, Box 850, Boston, MA 02111, USA
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Simon N, Quyyumi SA, Rothman JG. Follicular Thyroid Cancer Presenting as a Sellar Mass: Case Report and Review af the Literature. Endocr Pract 2004; 10:62-6. [PMID: 15251624 DOI: 10.4158/ep.10.1.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe an uncommon initial manifestation of well-differentiated follicular carcinoma of the thyroid in an unusual metastatic site. METHODS We present clinical, laboratory, and imaging findings in our patient and review related data from the literature. RESULTS A young healthy woman presented with headache and diplopia. Magnetic resonance imaging of the brain showed a complex mass in the sellar region. Endocrine evaluation was remarkable only for a modestly high serum prolactin level. Transsphenoidal biopsy of the sellar mass revealed metastatic follicular thyroid carcinoma. On subsequent examination, a thyroid nodule was palpated. She underwent total thyroidectomy and ablative therapy with 131I, after which her symptoms gradually subsided and the sellar mass ultimately decreased in size. Although well-differentiated thyroid cancer generally manifests as a thyroid nodule, metastatic disease is present at the time of initial assessment in approximately 1% of cases, and the lungs and the skeleton are the most frequent sites of involvement. Only a few cases of thyroid cancer metastasizing to the sella have been reported. Described cases occurred mainly in elderly patients with previously diagnosed thyroid cancer. The most common malignant tumors that metastasize to the sella and pituitary are lung cancer in men and breast cancer in women. Metastatic tumors frequently manifest with cranial nerve palsies or diabetes insipidus and occur in elderly patients. CONCLUSION Follicular thyroid cancer can manifest initially as a distant metastatic tumor in young patients. Metastatic lesions should always be in the differential diagnosis of a sellar mass, even in young patients.
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Affiliation(s)
- Nicole Simon
- SUNY-Health Science Center at Brooklyn, Brooklyn, New York, USA
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Kachhara R, Nair S, Radhakrishnan VV, Pandey M, Ahmed MI, Kumar A, Bhattacharya RN. Solitary metastasis from occult follicular carcinoma of the thyroid mimicking trigeminal neurinoma--case report. Neurol Med Chir (Tokyo) 2001; 41:360-3. [PMID: 11488002 DOI: 10.2176/nmc.41.360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 50-year-old woman presented with an extremely uncommon case of solitary metastasis from follicular carcinoma of the thyroid, which presented clinically as trigeminal neurinoma. Neuroimaging detected a tumor in the right petrous apex, which was removed surgically. Histological examination showed metastatic follicular carcinoma of the thyroid. However, no primary tumor was detected by various investigations. The tumor recurred twice, and was treated surgically both times. The patient finally agreed to adjuvant therapy for the suspected primary. Radiotherapy was performed followed by complete thyroidectomy. Examination of the gross specimen found the tumor nodule. Clinically significant metastasis can arise from histologically benign and silent follicular thyroid neoplasms.
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Affiliation(s)
- R Kachhara
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Rosahl SK, Erpenbeck V, Vorkapic P, Samii M. Solitary follicular thyroid carcinoma of the skull base and its differentiation from ectopic adenoma--review, use of galectin-3 and report of a new case. Clin Neurol Neurosurg 2000; 102:149-55. [PMID: 10996713 DOI: 10.1016/s0303-8467(00)00088-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With only four histologically proven cases in the literature, solitary skull base metastasis of thyroid carcinoma is extremely rare. Having treated another patient harboring a lesion with osseous destruction in the petroclival region and downward soft tissue extension we analyzed this case in conjunction with previous reports. In contrast to parenchymal brain metastasis that usually consists of the papillary type, histological examination revealed differentiated follicular tumors in all cases. All were located around the clivus. The radiographic picture resembled that of chordomas or chondrosarcomas. In the tissue obtained during thyroidectomy no evidence of primary malignancy was found in any of the cases according to standard histological criteria. In our case, a recently developed immunocytological marker - galectin-3 - was applied to differentiate between ectopic thyroid adenoma and carcinoma. The results were indicative of anaplastic growth. Tumor remnants responded well to postoperative 131I internal radiation and TSH suppression therapy. Distant metastasis of follicular thyroid carcinoma has to be considered in the differential diagnosis of destructive skull base lesions. Histological evaluation should include immunohistochemistry or clonal analysis to differentiate between adenomatous and carcinomatous growth and initiate effective radiotherapy early. Prognosis is by far not as poor as in brain metastases and appears to depend largely on location, size and histological appearance.
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Affiliation(s)
- S K Rosahl
- Department of Neurosurgery, Nordstadt Hospital, Haltenhoffstr. 41, D-30167 Hannover, Germany.
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Brierley JD, Panzarella T, Tsang RW, Gospodarowicz MK, O'Sullivan B. A comparison of different staging systems predictability of patient outcome. Cancer 1997. [DOI: 10.1002/(sici)1097-0142(19970615)79:12<2414::aid-cncr18>3.0.co;2-u] [Citation(s) in RCA: 164] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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