Solitary cerebral metastasis from a papillary carcinoma of the thyroid

TCR-Seq Identifies Distinct Repertoires of Distant-Metastatic and Nondistant-Metastatic Thyroid Tumors

CONTEXT

Malignant thyroid tumor with distant metastasis is associated with poor outcome. Early detection of distant metastasis is of great clinical importance.

OBJECTIVE

Thyroid tumor infiltrated with T cells can serve as a biomarker for monitoring metastasis.

DESIGN

A retrospective analysis was performed of patient clinical samples collected between 2012 to 2018, using T-cell receptor sequencing (TCR-seq) for clinical exploration.

SETTING

This study took place at Zhejiang Cancer Hospital.

PATIENTS

Sixty-eight patients with papillary thyroid cancer (PTC) (distinct metastatic status) and 21 patients with benign nodules were enrolled. All patients had not received any treatment before surgery.

MAIN OUTCOME MEASURE

The characteristics of TCRβ complementary-determining region 3 (CDR3) for each patient were determined by high-throughput sequencing.

RESULTS

The TCRβ diversity of malignant tumors is significantly higher than benign nodules both in blood and tumor samples (Shannon index, blood, P < .01; tumor, P < .001). The malignant tumors with distant metastasis or invasiveness showed lower TCRβ diversity than nonmetastasis (Shannon index, P < .01) or noninvasive (Shannon index, P < .01) malignant tumors. Analysis of the Morisita-Horn similarity index indicated significant TCRβ repertoire similarity between tumor and blood in distant-metastatic patients (comparison with nonmetastasis, P < .05). According to the discrepancy of the CDR3 among patients with different clinicopathological status, the classifier was constructed to discriminate distant-metastatic individuals. A promising area under the curve value of 83.8% was obtained with the number of overlapping CDR3 clonotypes.

CONCLUSION

The availability and reliability of TCR-seq render it prospective to translate these intrinsic attributes into clinical practice for monitoring distant metastasis in PTC patients.

Brain Metastases From Differentiated Thyroid Carcinoma: Prevalence, Current Therapies, and Outcomes

BACKGROUND AND OBJECTIVE

The brain is an unusual site for distant metastases of differentiated thyroid carcinoma (DTC). The aim of this study was to document the prevalence of brain metastases from DTC at our institutions and to analyze the current therapies and the outcomes of these patients.

METHODS

We performed a retrospective chart review of patients with DTC and secondary neoplasia of the brain.

RESULTS

From 2002 to 2016, 9514 cases of thyroid cancer were evaluated across our institutions and 24 patients met our inclusion criteria, corresponding to a prevalence of 0.3% of patients with DTC. Fourteen (58.3%) were female and 10 (41.7%) were male. Fifteen patients had papillary thyroid cancer (PTC) (62.5%). Brain metastases were diagnosed 0 to 37 years (mean ± SD, 10.6 ± 10.4 years) after the initial diagnosis of thyroid cancer. Patients undergoing surgery had a median survival time longer than those that did not undergo surgery (27.3 months vs 6.8 months; P = 0.15). Patients who underwent stereotactic radiosurgery (SRS) had a median survival time longer than those that did not receive SRS (52.5 months vs 6.7 months; P = 0.11). Twelve patients (50%) were treated with tyrosine kinase inhibitors (TKIs), and they had a better survival than those who have not used a TKI (median survival time, 27.2 months vs 4.7 months; P < 0.05).

CONCLUSION

The prevalence of brain metastases of DTC in our institutions was 0.3% over 15 years. The median survival time after diagnosis of brain metastases was 19 months. In our study population, the use of TKI improved the survival rates.

Solitary Brain Metastases from Thyroid Carcinoma: Study of 6 Cases

Aims and background

Although systemic metastases from thyroid cancer are relatively frequent, they rarely affect the nervous system and only exceptionally originate from well-differentiated carcinoma.

Methods

The authors describe 6 cases of solitary brain metastases from thyroid carcinoma, well-differentiated in 3 cases and anaplastic in the other 3 cases.

Results

Four patients were females and 2 males (M:F ratio, 1:2); average age was 51 yrs (range 48-56). On average, the interval between diagnosis of the thyroid tumor and appearance of the metastasis was 2.8 years (range 1-12 years) and was shorter in the anaplastic forms (1.2 versus 4.4 years). Average survival was 15 months (range 6-48 months); in particular, average survival was longer in patients with well-differentiated carcinoma (9 vs 21 months) as also in those who did not present other metastatic sites (6 vs 24 months). Death was due to systemic progression of the disease in 4 cases and to brain-relapse in the other 2 cases.

Conclusions

Surgery, radioactive iodine (where uptake is demonstrable), and radiotherapy are the main therapies available for metastases from thyroid carcinoma. However, survival of patients appears to be modified by the type of treatment performed.

Brain Metastases in Well-Differentiated Carcinoma of the Thyroid

Fifteen patients (4 males and 11 females) developed brain metastases from well-differentiated thyroid cancer within 1 month to 14 years of the initial diagnosis. One patient presented with a brain tumor. Except for 3 patients with unique brain metastases, all the others had extensive metastases in nodes, lungs and bones in various combinations. Brain metastases generally appeared after the onset of metastases at other sites. The histology of the brain tumor matched the primary pathology in the 6 operated cases. The treatment was surgery and external radiation in 6 cases, and radioiodine or chemotherapy in the others. Survival in general was less than 6 months after the diagnosis of brain metastases. The prognosis is poor once the onset of brain metastases is evident.

Management of Solitary Intracranial Metastases of Differentiated Thyroid Carcinoma: 11 Pathologically Confirmed Cases and Systematic Literature Review

BACKGROUND

Solitary intracranial metastases of differentiated thyroid carcinoma (DTC) are rare, and their management is still controversial. This research aimed to seek suitable therapeutic methods for this disease.

METHODS

We retrospectively studied 11 pathologically confirmed cases of solitary intracranial metastases of DTC in a single institution from January 2000 to December 2016 and systematically reviewed 52 cases of this disease out of 416 cases described in the literature on PubMed. These 63 cases were analyzed by Kaplan-Meier analysis, Cox regression analysis, and post-hoc test.

RESULTS

The diameters of intracranial metastases in all 63 cases were greater than 2 cm. Lung metastases (P = 0.000) and neurosurgery (P = 0.014) were 2 independent prognostic factors of this disease. Only neurosurgery (P = 0.05) was an independent prognostic factor in the patients with lung metastases, and neurosurgery (P = 0.044) and whole brain radiotherapy (WBRT) (P = 0.041) were 2 independent factors in the patients without lung metastases. Longer overall survival (OS) was achieved in the gross total removal (GTR) and subtotal removal (STR) groups than in the no neurosurgery group (P = 0.015, P = 0.084, respectively), and there was no significance between the GTR and STR groups (P = 0.918).

CONCLUSION

The patients without lung metastases had a better prognosis than did the patients with lung metastases. Neurosurgery could obviously improve the prognosis, and if possible, GTR of metastases was supposed to be achieved; STR could be considered. WBRT was a suitable method after neurosurgery in the patients without lung metastases but could not prolong OS in the patients with lung metastases.

Brain-Only Metastases Seen on FDG PET as First Relapse of Papillary Thyroid Carcinoma Two Years Post-Thyroidectomy

We report a case of a 60-year-old man diagnosed with papillary thyroid cancer who had a relapse seen only in the brain at FDG PET on standard images. Total thyroidectomy was performed in July 2013 after initial diagnosis. Patient received I ablation in December 2013, followed by external beam radiotherapy to the neck. In September 2015, the patient presented with neurological symptoms. Brain MRI showed multiple brain metastases later confirmed on histopathology. An FDG PET/CT scan was performed to evaluate the whole body in November 2015. Multiple hypermetabolic lesions were identified in the brain with no other lesion up to mid thighs.

Intramedullary spinal cord metastasis arising from papillary thyroid carcinoma: A case report and review of literature

Background:

Intramedullary spinal cord metastases (IMSCM) are typically drop lesions from intracranial metastases and are a rare manifestation of systemic malignancy (8.5% of central nervous system metastases). They arise from primaries such as the lungs, breast, kidney, melanoma, or lymphoma. On the other hand, they arise very rarely from papillary thyroid carcinoma (PTC), even though it is the most common type of primary thyroid malignancy.

Case Description:

A 54-year-old male presented with pain in the lower back along with tingling, numbness, and weakness in the bilateral lower limbs. This was associated with urine incontinence for 1½ months. In the previous month, he developed a left-sided solitary thyroid nodule. Fine needle aspiration cytology and ultrasonography were suggestive of metastasis. Furthermore, the thoracolumbar magnetic resonance imaging showed T1-hypo and T2-hyper-intense D11-D12 level intramedullary lesion, with intense enhancement, which was consistent with an intramedullary lesion involving the conus. At surgery, a firm, brownish yellow, friable, vascular tumour was removed en toto. Upon discharge, the patient was neurologically intact except for residual bladder incontinence.

Conclusion:

In an extensive literature review (pubmed), IMSCM metastasis from PTC primary is confirmed as a rarity and this may be the fourth documented case. Moreover, this may be the first report of a case of PTC metastatic neurological deterioration “even before the treatment of the primary was undertaken.” Early diagnosis and microsurgical resection can result in improvement of neurological deficits and in the quality of life of patients with IMSCM.

Asymptomatic solitary cerebral metastasis from papillary carcinoma thyroid: 131I SPECT/CT for accurate staging

Isolated asymptomatic brain metastasis in papillary carcinoma thyroid (PCT) is extremely rare. We here present such a case of a 48-year-old woman with PCT. SPECT/CT localized the 131I radiotracer concentration seen on whole-body scan in this patient to the right posterior parietal cortex, suggesting brain metastasis. Contrast-enhanced MRI and 18F-FDG PET/CT confirmed the diagnosis and the patient was taken for gamma-knife radiosurgery. 131I SPECT/CT in this case accurately restaged the patient by detecting asymptomatic isolated brain metastasis and correctly directed the management strategy.

Intradural extramedullary metastasis from papillary carcinoma of thyroid

Although spinal metastasis is a common finding in malignancies, however intradural extramedullary metastasis is very rare. This paper presents a 71-year-old woman, known case of papillary carcinoma of thyroid with intradural extramedullary metastasis in thoracic spine.

Papillary thyroid carcinoma with brain metastases: an unusual 10-year-survival case

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy with indolent clinical course and good prognosis. Brain metastases are extremely rare and the average survival time after diagnosis has been reported to be around 12 months.

SUMMARY

We here report a 69-year-old patient who was admitted to the emergency room in January 2000 with progressive dizziness, headache, and vomiting. Five years before admission the patient underwent partial thyroidectomy for goiter. On admission, a diagnostic evaluation that included brain magnetic resonance imaging showed multiple brain lesions, and a stereotactic biopsy demonstrated a metastatic carcinoma from primary PTC, with the neoplastic cells staining for thyroglobulin. Total thyroidectomy was then performed, which showed colloid goiter and a PTC metastasis on a cervical lymph node. The patient received 200 mCi of radioactive iodine ((131)I) with suppressive therapy with l-thyroxine thereafter. Subsequently, serial whole-body scanning and magnetic resonance imaging showed multiple brain metastases and the patient received further (131)I treatment, with a total dose of 1.2 Ci in a 10-year span. She also underwent partial surgical resection of brain metastases because complete resection was not feasible. Thereafter, the patient was subjected to whole-brain body radiotherapy with a dose of 44 Gy, followed by two brain gamma knife radiosurgeries (15 Gy each). To date, biochemical tests are within the normal range and the patient remains asymptomatic.

CONCLUSIONS

To our knowledge, this is the first report of a 10-year-survival case of brain metastases from PTC, despite this being a bad prognostic factor. A combined approach of surgical excision, (131)I, whole-brain radiotherapy, and gamma knife radiosurgery was successful to treat metastases derived from primary tumor.

Cerebellar mass as a primary presentation of papillary thyroid carcinoma: case report and literature review

Background

Papillary carcinoma is the most common differentiated malignant thyroid neoplasm. The biological course of this cancer is typically indolent with a protracted clinical course. Metastases commonly occur in regional lymph nodes, and distant metastasis is a late and rare occurrence. We report a patient who presented with cerebellar metastasis prior to the diagnosis of papillary thyroid carcinoma and review the literature of brain metastasis from papillary thyroid carcinoma.

Results

A 75-year old female presented at the emergency room with progressive dizziness, headache and vomiting, where a brain CT and MRI showed a posterior cerebellar tumor. Surgical resection revealed papillary carcinoma consistent with thyroid origin. Subsequent ultrasound and CT-scan revealed a thyroid nodule, after which the patient underwent total thyroidectomy. Pathologic evaluation was consistent with papillary thyroid carcinoma.

Conclusion

Brain metastasis may rarely be the initial presentation of papillary thyroid carcinoma. Solitary brain metastasis can completely be resected with better prognosis.

Intracranial metastasis from medullary carcinoma of the thyroid 25 years after primary surgery

Medullary carcinoma of the thyroid is an uncommon tumour. In most patients, it is confined to the neck with or without involvement of the local cervical nodes. It rarely metastasizes to the mediastinum, lungs or liver. Intracranial metastasis is extremely rare with very few reported cases in the literature. We report an unusual case of an intracranial metastasis from a medullary carcinoma of the thyroid that occurred 25 years after primary surgery. We discuss the unusual features of our case together with a review of the literature.

Thyroid follicular carcinoma metastasized to the lung, skull, and brain 12 years after initial treatment for thyroid gland--case report

A 65-year-old woman presented with multiple metastases from thyroid follicular carcinoma to the lung, skull, and brain. The skull and brain tumors had been successfully treated by surgery, thyroxine supplementation, and radiosurgery until she died of sudden intracerebral hemorrhage which had no connection with tumor treatment. The lung tumor was treated by conventional irradiation and radioactive ablation. Well-differentiated thyroid carcinoma is a slowly progressive tumor. Follicular carcinoma is thought to have the most optimistic prognosis even with metastases to the lymph nodes and lung. Radioactive ablation using iodine-131 is widely used to treat the primary and/or metastatic lesion. However, the prognosis for patients with brain metastases is poor. Intracranial metastasis of this tumor is rare, but has a mean posttreatment survival of around 12 months. Surgical excision of the metastatic intracranial lesion may be the only effective treatment.

Intrathyroideal papillary thyroid carcinoma presenting with a solitary brain metastasis

Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid carcinoma and typically has an excellent prognosis. The incidence of distant metastasis from PTC is low. However, once metastasis has developed in a distant site, prognosis is markedly diminished. Brain metastases from PTC are extremely rare. No consensus regarding management has yet been reached. We report on the case of a patient who presented with signs of intracranial hypertension. Cranial magnetic resonance imaging (MRI) identified a lesion of the right temporofrontoparietal lobe. The patient underwent a craniotomy with a total removal of the tumor. Histologic examination of the lesion showed a metastasis of papillary adenocarcinoma. We observed a cold nodule in the right lobe of the thyroid on physical examination and imaging techniques (e.g., CT and scintigraphy). Fine-needle-aspiration cytology of the nodule was reported as PTC. A total thyroidectomy was performed and histopathological examination showed intrathyroidal variant of PTC. Postoperatively adjuvant whole brain radiation therapy with 44 Gy to multiple brain metastases of PTC was applied. One month later, the patient then underwent 131I radioiodine therapy with 150 mCi of 131I given orally. In conclusion, the present case underwent an aggressive multimodal approach to therapy. This report indicates that the early detection and control of brain metastases may contribute to a better quality of life for patients affected by brain metastases.

Unusual brain metastases from papillary thyroid carcinoma: case report

OBJECTIVE AND IMPORTANCE

Brain metastases from papillary carcinoma of the thyroid gland are unusual. No consensus regarding management has yet been reached. We report a case, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data.

CLINICAL PRESENTATION

A 33-year-old woman presented with signs of intracranial hypertension. The diagnostic evaluation included chest tomography, head computed tomography, brain magnetic resonance imaging with and without contrast enhancement, total-body scanning, and cerebral scintigraphy. Multiple supratentorial lesions and one right cerebellopontine angle lesion were observed. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland.

INTERVENTION

A ventriculoperitoneal shunt was placed and a right suboccipital craniotomy was performed, with complete removal of the cerebellopontine angle tumor. Total-brain irradiation with 40 Gy/lesion followed the initial operation. One year after surgery, the patient presented with signs of increased intracranial pressure. A new left frontal lobe lesion with massive peritumoral edema was identified on magnetic resonance imaging scans. The edema was treated clinically and a left frontal craniotomy was performed, with complete resection of the tumor. The patient is currently faring well, with residual expressive aphasia.

CONCLUSION

Surgery followed by radiotherapy seems to be a good alternative for the treatment of this specific type of metastasis. Thorough clinical and radiological evaluation, followed by genetic analysis of the surgical specimen, particularly with respect to the potential for tumor invasion under specific conditions, is recommended. The information obtained contributes to better management and better overall long-term outcomes for these patients.

Single brain metastasis from thyroid cancer: report of twelve cases and review of the literature

Brain metastases from thyroid carcinoma is unusual, with a frequency of 1%. We report twelve patients, with single brain metastases and with a karnofsky performance scale score >60 at admission. No metastasis was seen during the uptake of iodine-131, even in the cases from differentiated thyroid carcinoma, suggesting absence of differentiation between primary and metastasic disease. The histopathology of thyroid carcinomas was anaplastic in five cases, differentiated in six, and medullary in one. Only in four patients, brain was the unique site of metastatic spread; in others, bones and lungs were also involved. All metastases were surgically removed, and all patients were treated with radiotherapy (45 Gy) in the postoperative course. The survival average was 19.8 months, and the quality of life was satisfactory in all patients. One patient remained alive till 5 years. Anaplastic histopathology and size of the primitive, and also bone involvement of thyroid disease were significant risk factors in our cases (p < 0.05). According to the literature, surgery is the best therapeutical choice. Alternative strategies in the management of brain metastasis, such as iodine-131 therapy, are discussed, paying particular attention to the relevant side effects.

Cerebellopontine angle metastasis from papillary carcinoma of the thyroid: case report and literature review

BACKGROUND

Papillary thyroid carcinoma is the most common type of well-differentiated thyroid malignancy and typically has an excellent prognosis and a low incidence of distant metastasis. However, once metastasis has developed in a distant site, prognosis is markedly diminished. Brain metastases from papillary thyroid carcinoma are extremely rare. Currently, there are no established therapeutic guidelines for treating brain metastases from thyroid carcinoma.

CASE DESCRIPTION

We report on the case of a patient who presented with worsening neurological symptoms 3 years after resection of a thyroid papillary carcinoma. Magnetic resonance imaging identified a lesion of the cerebellopontine angle that encased the lower cranial nerves. The patient underwent a left retrosigmoid craniotomy with a 98% resection of the mass and received postoperative adjuvant radioiodine therapy, external beam radiation, and Gamma Knife radiosurgery. The patient tolerated the procedure well and demonstrated significant progressive improvement in her neurological symptoms postoperatively. After the multimodal approach to therapy, she remains symptom-free at 3-year follow-up. Radiographic monitoring of the small tumor remnant reveals a decrease in size from the postoperative period.

CONCLUSION

This article is the first formal case report of cerebellopontine angle metastasis from papillary thyroid carcinoma. Therapeutic protocols for brain metastases of papillary thyroid carcinoma are not firmly established. This case illustrates the unique event of a cerebellopontine angle metastasis from papillary thyroid carcinoma, which was successfully treated with a combination of surgical, chemical, and radiological modalities. This aggressive course of therapy has resulted in an excellent outcome in this instance.

Multiple brain metastases from a diffuse sclerosing variant of papillary carcinoma of the thyroid

We report a 53-yr-old man who presented with multiple brain metastases from a diffuse sclerosing papillary carcinoma of the thyroid. The presenting clinical features were those of an intracranial space-occupying lesion. Three brain tumors, confirmed pathologically to be metastatic thyroid papillary carcinomas, were removed. Two weeks after craniotomy, total thyroidectomy with cervical lymph node dissection was performed. Both lobes of the thyroid were diffusely enlarged and firm with a dominant mass. Histologically, the tumor was characterized by a combination of bilateral diffuse involvement of the gland, marked fibrosis, squamous metaplasia, abundant psammoma bodies, lymphocytic infiltration, frequent lymphatic and blood vessel permeation of the tumor, and typical elements of a conventional papillary carcinoma. In addition to these histologic findings, elements of other papillary carcinoma variants such as follicular and tall cell variants were also found focally. Twenty-three of twenty-four resected bilateral lymph nodes showed metastases of papillary carcinoma. Although the diffuse sclerosing variant of papillary carcinoma of the thyroid seems to be recognized as an aggressive variant of papillary carcinoma, there is no previous report of brain metastasis from this variant.

Solitary cerebellar metastasis from papillary thyroid carcinoma: a case report

Papillary thyroid carcinoma is a common thyroid malignancy that generally has a good prognosis. However, this type of cancer may give rise to distant metastasis and may behave more aggressively in older patients. Here we report clinical, radiological, and pathological findings of a patient with papillary thyroid carcinoma who had a solitary cerebellar metastasis. The patient was known to have metastatic thyroid cancer to the lungs, but this had been stable and the cerebellar metastasis presented an unanticipated significant problem. The rapid detection of cerebellar metastatic disease is critical because neurosurgical removal of the solitary lesion should be considered as the treatment of choice. This case also serves to remind us of the importance of considering possible metastatic brain lesions and their acute life-threatening complications in contrast to the relatively prolonged course associated with metastases of thyroid carcinoma to other organs.

Case report: brain metastases from papillary carcinoma thyroid

Papillary carcinoma, the commonest thyroid malignancy, has a good prognosis and low incidence of distant metastases. Brain metastasis is extremely rare with a frequency of 0.1-5% in reported series. The clinical details of two cases of histologically proven brain metastases from papillary thyroid cancer treated in our centre are presented. In one patient, the lesion was in the cerebellar hemisphere, and in the other, the frontal lobe. Also presented is a review of the literature of this unusual clinical presentation.

Management of intracranial metastases of differentiated carcinoma of thyroid

Brain metastases in differentiated carcinoma of the thyroid is a rare occurrence. We treated five documented cases of carcinoma of thyroid with brain metastases out of 400 cases of thyroid cancer treated between 1972 to 1993. 4 were females out of which one was pregnant during the appearance of brain metastases. All cases were treated with thyroidectomy, and radioiodine as primary therapy. Brain metastases developed 6 months to 11 years following treatment of the primary and were treated with radiotherapy and suppressive levothyroxine. We observed the beneficial effect of suppressive thyroxine and the poor prognosis associated with pregnancy and withdrawal of thyroid replacement therapy. 3 of the 5 patients are alive 12-23 months after treatment for brain metastases, while 2 patients died at 4 months and 7 years post brain metastases due to pulmonary and hepatic failure, respectively.