1
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Metastasis of Papillary Thyroid Carcinoma to the Maxillary Sinus: Case Report and Review of the Literature. Case Rep Otolaryngol 2020; 2020:4056901. [PMID: 32455039 PMCID: PMC7240621 DOI: 10.1155/2020/4056901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
Metastasis of the thyroid carcinoma to the paranasal sinuses is rarely reported. Among these sinuses, metastasis to the maxillary sinus alone has been reported only in a few cases. This is the first reported case in a 76-year-old woman with papillary thyroid carcinoma metastasizing to the maxillary sinus alone and resected through endoscopic sinonasal surgery. When patients have sinus lesions and a history of malignancy, metastasis should be included in the differential diagnosis. If they have an isolated metastatic lesion to the paranasal sinus, ESS, either palliative or radical, can be a useful treatment option.
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2
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Bile-Gui LN, Kouadio E, Ohui-Acko EV, Kabas RM, Koui SB, Diambra LMA, Kouao JPS. Metastatic thyroid carcinoma presented as a large craniofacial mass: Case report and CT findings. Radiol Case Rep 2019; 15:128-132. [PMID: 31798760 PMCID: PMC6881619 DOI: 10.1016/j.radcr.2019.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022] Open
Abstract
Cranial metastases are uncommon locations of thyroid papillary carcinoma. They significantly reduce patients’ survival, especially in a context of late management. We report the case of a 46-year-old woman who presented an anterior cervical swelling, then a progressive large craniofacial mass for more than 5 years without any treatment. The imaging performed showed a large craniofacial tissue mass with frontotemporal and right orbital bone destruction extended to the face sinuses and the underlying extradural space without brain involvement; the second thyroid tumor right site had similar imaging characteristics to the cranial mass. The diagnosis of papillary carcinoma with craniofacial metastasis was retained after cranial biopsy and thyroid cytology. At this stage, a cranial surgery has not been proposed but a palliative hormonal treatment. The patient died 2 weeks after diagnosis. This case illustrates the relevant role of imaging in the assessment of thyroid tumors and the value of early management for improving patients’ survival.
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Affiliation(s)
- Lynda N Bile-Gui
- Radiodiagnostic and Medical Imaging Department of Treichville Hospital and University Center, Abidjan, Côte d'Ivoire.,University Felix Houphouet Boigny, Medical sciences department, Abidjan, Côte d'Ivoire
| | - Eric Kouadio
- Radiodiagnostic and Medical Imaging Department of Treichville Hospital and University Center, Abidjan, Côte d'Ivoire.,University Felix Houphouet Boigny, Medical sciences department, Abidjan, Côte d'Ivoire
| | - Estelle Valérie Ohui-Acko
- Radiodiagnostic and Medical Imaging Department of Treichville Hospital and University Center, Abidjan, Côte d'Ivoire.,University Felix Houphouet Boigny, Medical sciences department, Abidjan, Côte d'Ivoire
| | - Raissa M Kabas
- Radiodiagnostic and Medical Imaging Department of Treichville Hospital and University Center, Abidjan, Côte d'Ivoire.,University Felix Houphouet Boigny, Medical sciences department, Abidjan, Côte d'Ivoire
| | - Sylvanus B Koui
- University Felix Houphouet Boigny, Medical sciences department, Abidjan, Côte d'Ivoire.,Department of pathology of Treichville Hospital and university center, Abidjan, Côte d'Ivoire
| | - Lolo M A Diambra
- Radiodiagnostic and Medical Imaging Department of Treichville Hospital and University Center, Abidjan, Côte d'Ivoire
| | - Jean-Paul S Kouao
- Radiodiagnostic and Medical Imaging Department of Treichville Hospital and University Center, Abidjan, Côte d'Ivoire
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3
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Sheikh AB, Akhtar A, Tariq U, Sheikh AAE, Siddiqui FS, Bukhari MM. Skull Metastasis Extending to the Superior Sagittal Sinus: An Unfamiliar Presentation of Papillary Thyroid Carcinoma. Cureus 2018; 10:e2738. [PMID: 30087814 PMCID: PMC6075641 DOI: 10.7759/cureus.2738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thyroid cancer is the most common endocrine cancer in the world, with a rising global incidence over the last three decades. Papillary thyroid cancer (PTC) is the most common type of thyroid neoplasia, accounting for 74%-80% of all cases. Skull metastasis from a differentiated thyroid malignancy is a rare occurrence, while a subsequent dural involvement is even more inimitable. As such, a clinician requires a high degree of clinical suspicion and resultant radiographic evidence in order to make the diagnosis. Here we present the case of a 54-year-old male patient who presented with a pathological fracture of his right humerus, a midline frontal bone swelling and an asymptomatic neck mass. Further workup revealed follicular variant papillary thyroid carcinoma (FV-PTC) with distant metastasis to the calvarium. The conventional therapy for metastatic PTC includes a total thyroidectomy, removal of resectable metastatic lesions and a supplementation with radioactive iodine (RAI) and/or external beam radiation at the sites of the metastases. This case and our literature review illustrate that skull metastases should be considered in the clinical course of PTC so that appropriate management can be started.
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Affiliation(s)
| | - Aisha Akhtar
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | | | | | - Marvi M Bukhari
- Internal Medicine, Shifa College Of Medicine, Islamabad, PAK
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4
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Varadarajan VV, Pace EK, Patel V, Sawhney R, Amdur RJ, Dziegielewski PT. Follicular thyroid carcinoma metastasis to the facial skeleton: a systematic review. BMC Cancer 2017; 17:225. [PMID: 28351395 PMCID: PMC5370488 DOI: 10.1186/s12885-017-3199-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/15/2017] [Indexed: 12/19/2022] Open
Abstract
Background Follicular thyroid carcinoma (FTC) metastasis to the facial skeleton is exceedingly rare. A case of FTC metastasizing to the mandible is presented and a systematic review of the literature describing thyroid metastasis to the facial skeleton is performed. Case presentation A 73-year-old female presented with metastatic FTC to the mandible and underwent total thyroidectomy, segmental mandibulectomy, bone impacted fibular free flap reconstruction, and adjuvant radioactive iodine treatment. The PubMed database was searched for literature describing thyroid cancer with facial skeleton metastasis using the key words “thyroid,” “cancer,” “carcinoma,” “metastasis,” and “malignancy” with “oral cavity,” “maxilla,” “mandible,” “sinus,” “paranasal,” and “orbit.” Reports that only involved the soft tissues were excluded. Systematic review revealed 59 cases of well-differentiated thyroid cancer with facial skeleton metastasis: 35 mandibular metastases (21 = FTC), 6 maxilla metastases (2 = FTC), 9 orbital metastases (4 = FTC), and 11 paranasal sinus metastases (7 = FTC). Treatment included surgery, RAI, external beam radiotherapy (XRT), or a combination of these modalities. The one, two, and five-year survival rates were 100%, 79%, and 16%, respectively. Conclusion Facial skeleton metastasis of FTC is a rare clinical challenge. Optimal treatment appears to include total thyroidectomy and resection of involved structures with or without adjuvant treatment.
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Affiliation(s)
- Varun V Varadarajan
- Department of Otolaryngology (ENT), University of Florida, Gainesville, FL, 32610, USA
| | | | - Vatsal Patel
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Raja Sawhney
- Department of Otolaryngology (ENT), University of Florida, Gainesville, FL, 32610, USA
| | - Robert J Amdur
- University of Florida Health Cancer Center, Gainesville, FL, USA.,Department of Radiology, University of Florida, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology (ENT), University of Florida, Gainesville, FL, 32610, USA. .,University of Florida Health Cancer Center, Gainesville, FL, USA.
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5
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Yari N, Espino Barros Palau A, Morgan ML, Levine NB, Lee AG. Metastatic Papillary Thyroid Carcinoma Presenting as Abducens Palsy Complicated by Ocular Neuromyotonia. Neuroophthalmology 2016; 40:97-101. [PMID: 27928392 DOI: 10.3109/01658107.2015.1132742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/12/2015] [Accepted: 12/13/2015] [Indexed: 11/13/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is a type of well-differentiated thyroid cancer that accounts for the majority of thyroid malignancies. The prognosis of PTC is very good and distant metastases are rare, especially to the skull base. The authors report the case of a 47-year-old woman with biopsy-proven PTC treated with surgery and radiation therapy who presented with headache and diplopia after 5 years and was found to have clivus and cavernous sinus metastasis. Following radiation therapy for her skull base and cavernous sinus lesion, she subsequently developed sixth nerve ocular neuromyotonia. Possible causes and treatments are reviewed.
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Affiliation(s)
- Niloofar Yari
- Department of Neurology, Baylor Scott and White Health , Temple, Texas, USA
| | | | - Michael L Morgan
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University School of Medicine , Cleveland, Ohio, USA
| | | | - Andrew G Lee
- UT MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas, USA; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, Texas, USA; University of Texas Medical Branch, Galveston, Texas, USA
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6
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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7
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Tunio MA, Al Asiri M, Al-Qahtani KH, Aldandan S, Riaz K, Bayoumi Y. Skull base metastasis from papillary thyroid carcinoma: a report of three cases. Int Med Case Rep J 2015. [PMID: 26203287 PMCID: PMC4487156 DOI: 10.2147/imcrj.s82792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Skull base metastasis from differentiated thyroid carcinoma, including papillary and follicular thyroid carcinoma, is a rare manifestation. Herein, we present three cases of skull base metastasis of papillary thyroid carcinoma. The mean age of the patients was 68.6 (65–74) years, and the mean interval between initial diagnosis and skull base metastasis was 56.3 (28–89) months. Cranial nerve palsies were seen in all patients. Intensity modulated radiation therapy to deliver 6,000–6,600 cGy to the skull base metastasis was given to all patients, in addition to partial resection in one patient. At the time of last follow-up, all skull base metastases were well controlled.
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Affiliation(s)
- Mutahir A Tunio
- Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mushabbab Al Asiri
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Hussain Al-Qahtani
- Department of Otolaryngology -Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sadiq Aldandan
- Department of Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Riaz
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Bayoumi
- Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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8
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Li X, Zhao G, Zhang Y, Ding K, Cao H, Yang D, Zhang J, Duan Z, Xin S. Skull metastasis revealing a papillary thyroid carcinoma. Chin J Cancer Res 2013; 25:603-7. [PMID: 24255586 DOI: 10.3978/j.issn.1000-9604.2013.09.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/23/2013] [Indexed: 01/26/2023] Open
Abstract
Although thyroid carcinoma is a relatively common form of malignancy, metastatic spread to the skull is rare. Here, we report a case of papillary thyroid carcinoma with frontal and parietal metastasis. A 61-year-old Chinese woman presented with a one year history of a growing mass on the center of the frontal and parietal bone, initially thought to be meningioma. Biopsy of the skull base mass after intracalvarium excision, indicated a tumor of thyroid origin. One month later the patient underwent a total thyroidectomy. Pathological examination confirmed a diagnosis of papillary thyroid carcinoma with frontal and parietal bone metastasis. Based on this experience, the key to successful management of the skull metastasis of thyroid carcinoma is prompt diagnosis and appropriate treatment. Skull metastasis should be considered at the outset of the clinical course of papillary thyroid cancer. To facilitate this, patients should be meticulously investigated by a multidisciplinary team to improve quality of life.
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Affiliation(s)
- Xi Li
- Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
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9
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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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10
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Metastasis of follicular variant of papillary thyroid carcinoma masquerading as primary temporal bone tumour. The Journal of Laryngology & Otology 2011; 125:528-32. [DOI: 10.1017/s0022215110002926] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:We describe the first published case of papillary thyroid carcinoma metastatic to the temporal bone.Case report:A 64-year-old woman presented with a large left temporal bone mass centred in the jugular foramen, initially thought to be a paraganglioma or schwannoma. She was simultaneously being investigated for a left-sided thyroid nodule, which was found to be unremarkable on repeated fine needle aspiration cytology. A biopsy of the temporal bone mass indicated that it was of thyroid origin. The patient underwent total thyroidectomy, which enabled a final diagnosis of follicular-variant papillary thyroid carcinoma with metastasis to the temporal bone.Conclusion:Although biopsy is not the usual management for many types of temporal bone mass, pathological investigation is recommended if the tumour has an atypical growth rate, location, spread and/or radiological features. Metastasis of papillary thyroid carcinoma to the skull base is extremely rare, and correct diagnosis is essential in order to pursue an effective treatment plan.
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11
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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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12
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Nishijima H, Kitahara N, Murata M, Egami N. [A case of papillary thyroid carcinoma metastatic to the sphenoid sinus presenting with epistaxis]. ACTA ACUST UNITED AC 2010; 113:62-6. [PMID: 20225705 DOI: 10.3950/jibiinkoka.113.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Distant metastasis from differentiated thyroid carcinoma is rare and metastasis to the paranasal sinus is extremely rare. We report a case of differentiated papillary thyroid carcinoma (PTC) with metastases to the sphenoid sinus presenting with epistaxis. An 81-year-old undergoing partial lobectomy for differentiated PTC 9 years earlier presented with intermittent epistaxis. Imaging showed a mass filling the sphenoid sinus and extending to the intracranial cavity. Histopathological diagnosis using endoscopic biopsy indicated a metastatic PTC tumor. Compared to the primary site, the metastatic tumor was poorly differentiated thyroid carcinoma. Despite external beam radiation therapy, her general condition worsened and she was moved to a hospice.
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13
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Morita N, Ikeda Y, Takami H. Clinical significance of p53 protein expression in papillary thyroid carcinoma. World J Surg 2009; 32:2617-22. [PMID: 18836853 DOI: 10.1007/s00268-008-9756-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although mutations in the p53 suppressor gene in thyroid carcinoma have usually been detected in anaplastic carcinoma, P53 protein expression has been detected immunohistochemically in papillary thyroid carcinoma (PTC). In the present study, we examined the immunohistochemical expression of P53 protein in PTC to investigate the relations between its expression and the clinicopathologic features. METHODS The study was performed on 68 patients in whom thyroidectomy with lymph node dissection had been performed to treat PTC at Teikyo University Hospital. Expression of P53 protein was evaluated immunohistochemically in sections of paraffin-embedded tissue in 68 primary tumors and 196 lymph node metastases. RESULTS Overexpression of P53 protein in the primary tumor was observed in 29 cases (43%). Statistical analysis revealed significant correlation between P53 protein expression in the primary tumor and large tumor size (unpaired t-test: p < 0.01), the presence of lymph node metastasis (unpaired t-test: p < 0.05), and the mean number of lymph node metastases (unpaired t-test: p < 0.05). Although 29 (43%) of the primary tumors overexpressed P53 protein, 143 (73%) of the metastatic lymph nodes overexpressed P53 protein irrespective of whether there was P53 overexpression by the primary tumor. CONCLUSIONS The results of this study suggest that immunohistochemistry for P53 in the primary tumor could be useful in the clinical evaluation of patients with PTC. Moreover, P53 protein overexpression in lymph node metastasis may be useful as a treatment guide or target for lymph node recurrences.
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Affiliation(s)
- Naomi Morita
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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14
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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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15
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Argibay Vázquez S, Lancha Hernández C, Martínez Muñiz A. Metastases in the sphenoidal sinus in a patient with papillary thyroid cancer. Clin Transl Oncol 2006; 7:324-7. [PMID: 16185596 DOI: 10.1007/bf02710273] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus.
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16
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Bell CD, Kovacs K, Horvath E, Smythe H, Asa S. Papillary carcinoma of thyroid metastatic to the pituitary gland. Arch Pathol Lab Med 2001; 125:935-8. [PMID: 11419981 DOI: 10.5858/2001-125-0935-pcotmt] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We describe a 35-year-old woman who presented with diabetes insipidus caused by metastatic papillary carcinoma of the thyroid involving the pituitary gland, 25 years after treatment for a papillary carcinoma of thyroid and 17 years after treatment for multiple pulmonary metastases. The literature contains 10 previously described cases of metastatic thyroid carcinoma involving the sella, but only 2 of these cases had unequivocal metastases to the pituitary gland, making the present case, to our knowledge, the third reported case of unequivocal hematogenous metastasis of thyroid carcinoma to the pituitary gland. The pituitary tumor was removed by transsphenoidal surgery, and the tissue was examined by conventional histology, extensive immunohistochemistry, and electron microscopy. The findings confirmed the tumor to be papillary thyroid carcinoma. To our knowledge, this is the first report citing use of thyroid transcription factor-1 to establish a thyroid source of a pituitary metastasis.
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Affiliation(s)
- C D Bell
- Division of Anatomical Pathology, Department of Laboratory Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
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Reino AJ. Factors in the pathogenesis of tumors of the sphenoid and maxillary sinuses: a comparative study. Laryngoscope 2000; 110:1-38. [PMID: 11037807 DOI: 10.1097/00005537-200010001-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS To explain the processes that lead to the development of tumors in the maxillary and sphenoid sinuses. STUDY DESIGN A 32-year review of the world's literature on neoplasms of these two sinuses and a randomized case-controlled study comparing the normal mucosal architecture of the maxillary to the sphenoid sinus. METHODS Analysis of a 32-year world literature review reporting series of cases of maxillary and sphenoid sinus tumors. Tumors were classified by histological type and separated into subgroups if an individual incidence rate was reported. Histomorphometry of normal maxillary and sphenoid sinus mucosa was performed in 14 randomly selected patients (10 sphenoid and 4 maxillary specimens). Specimens were fixed in 10% formalin, embedded in paraffin, and stained with periodic acid-Schiff (PAS) and hematoxylin. Histomorphometric analysis was performed with a Zeiss Axioscope light microscope (Carl Zeiss Inc., Thornwood, NY) mounted with a Hamamatsu (Hamamatsu Photonics, Tokyo, Japan) color-chilled 3 charge coupled device digital camera. The images were captured on a 17-inch Sony (Sony Corp., Tokyo, Japan) multiscan monitor and analyzed with a Samba 4000 Image Analysis Program (Samba Corp., Los Angeles, CA). Five random areas were selected from strips of epithelium removed from each sinus, and goblet and basal cell measurements were made at magnifications x 100 and x 400. RESULTS The literature review revealed that the number and variety of tumors in the maxillary sinus are much greater than those in the sphenoid. The incidence of metastatic lesions to each sinus is approximately equal. No recognized pattern of spread from any particular organ system could be determined. On histomorphometric study there were no statistically significant differences between the sinuses in the concentration of goblet cells, basal cells, or seromucinous glands. CONCLUSIONS Factors involved in the pathogenesis of tumors of the maxillary and sphenoid sinuses include differences in nasal physiology, embryology, morphology, and topography. There are no significant histological differences in the epithelium and submucous glands between the two sinuses to explain the dissimilar formation of neoplasms.
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Affiliation(s)
- A J Reino
- Manhattan Ear, Nose and Throat Associates, New York, New York 10128, USA
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