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Ntotsikas K, Lazarioti S, Daraki V, Drakos E, Tsakalomatis PN, Syntzanaki EK, Moustakis N, Marinis AI, Salapatas-Gkinis A, Xekouki P, Vakis A, Tsitsipanis C. Thyroglobulin as a Rapid and Cost-Effective Biomarker for Diagnosis of Thyroid Carcinoma Brain Metastasis: A Case Report of a Patient with Metastatic Hurthle Cell Thyroid Carcinoma. Am J Case Rep 2023; 24:e939025. [PMID: 37853680 PMCID: PMC10598507 DOI: 10.12659/ajcr.939025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 09/04/2023] [Accepted: 06/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Brain metastasis of papillary thyroid cancer (PTC) is rare. Treatment of these patients is challenging due to the lack of specific guidelines. Early diagnosis is accompanied by immediate treatment and less morbidity. Total resection of brain lesions may be unattainable when they include infiltration of eloquent areas. This report is of an 81-year-old man who had undergone total thyroidectomy for goiter in the past and presented with metastatic papillary thyroid carcinoma (PTC) to the neck after a gap of 16 years. After two years, the patient developed a solitary cystic brain PTC metastasis associated with raised thyroglobulin (Tg) inside the cystic lesion aspirated during brain surgery. CASE REPORT An 81-year-old male patient was admitted for a space-occupying brain lesion in the right frontal lobe. The patient's history included metastatic disease of PTC to the neck with cervical lymph node metastasis and local recurrence after surgery and radioactive iodine-131 treatment. The patient underwent craniotomy and removal of the lesion. The aspirated fluid was sent for cytological examination and measurement of Tg levels, which were interestingly high. Pathology of the brain lesion revealed infiltration of brain parenchyma from a metastatic lesion characterized by eosinophilic cells with irregular contours forming grooves, resulting in cytoplasmic pseudo-inclusions, an oncotic variant of PTC. CONCLUSIONS This report has shown that residual tissue may be present following total thyroidectomy and may be the origin of PTC with metastasis to the brain. The patient in this study suffered from a brain lesion that could be excised. However, aspiration of cystic compartments could provide a rapid diagnosis in patients with non-removable brain lesions.
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Affiliation(s)
- Konstantinos Ntotsikas
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Lazarioti
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Vasiliki Daraki
- Department of Endocrinology, University Hospital of Crete, Heraklion, Crete, Greece
| | - Elias Drakos
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Pathology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | - Nikolaos Moustakis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Anastasios I. Marinis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Paraskevi Xekouki
- Department of Endocrinology, University Hospital of Crete, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Antonis Vakis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Tsitsipanis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Heraklion, Crete, Greece
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