Skull base metastasis from papillary thyroid carcinoma: a report of three cases

Cytological features of endolymphatic sac tumors: Case studies with review of literature

Endolymphatic sac tumors are extremely rare, locally aggressive neoplasms that arise from the endolymphatic sac or duct, primarily in the intraosseous portion. These neoplasms show diverse histomorphological architectures and despite a bland cytologic appearance, can locally recur. Although the clinicopathological and radiological features of this entity are well characterized, the literature on cytological features is extremely sparse. Herein, we describe the cytological features of the endolymphatic sac tumors and discuss the relevant differential diagnoses.

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study

Introduction:

Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions.

Methods:

A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used.

Results:

Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Grave's disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions.

Conclusions:

Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.

Metastatic thyroid carcinoma presented as a large craniofacial mass: Case report and CT findings

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.

Occipital Condyle Syndrome Caused by Isolated Bone Metastases from Thyroid Cancer

Occipital condyle syndrome is a rare cause of pain in the head which is characterized by severe and persistent unilateral suboccipital headache with unilateral hypoglossal nerve palsy. We report an elderly female who presented with dysarthria and suboccipital headache. On further evaluation, she was found to have a solitary bone metastases from thyroid cancer. She was treated with local radiation therapy for pain relief, total thyroidectomy, and high-dose radioiodine therapy. The patient is presently free of pain with very good control of the thyroid cancer status.

Skull Metastasis Extending to the Superior Sagittal Sinus: An Unfamiliar Presentation of Papillary Thyroid Carcinoma

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.

Metastatic Papillary Thyroid Carcinoma Presenting as Abducens Palsy Complicated by Ocular Neuromyotonia

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.

Skull metastasis from follicular thyroid carcinoma: report of three cases and review of literature

Three patients' medical history, clinical manifestation, imaging characteristic, therapy and prognosis of calvaria metastasis from follicular thyroid carcinoma (FTC) in our hospital were retrospectively analyzed by reviewing medical literature. In case one, the tumor in frontal bone and fossa orbital was total resected, no further treatment was performed, the patient gave up on therapy and died of extensive metastasis at 22 months after the initial operation. In case two, the tumor in parietal and occipital bone was total resected, the subtotal resection of bilateral thyroid gland and isthmus was performed and combined with therapy of Levothyroxine and (131)I radio-iodine therapy, no evidence of tumor recurrence at 30 months after the primary operation. In case three, the tumor in occipital bone was gross total resected, total resection of bilateral thyroid gland and clearance of lymph node was performed after two months, adjunctive therapy with Levothyroxine, (131)I radio-iodine and skull radiotherapy, no evidence of tumor recurrence at 21 months after the primary operation. Correct diagnosis of calvaria metastasis from FTC preoperative is difficult because it's rarity, patients can survive for years after synthetic therapy including total resection of metastatic tumor, radical operation of thyroid carcinoma, adjunctive therapy of Levothyroxine, (131)I radio-iodine and skull radiotherapy.