|
|
|
2011, Volume 27, Number 2, Page(s) 154-156
|
|
|
DOI: 10.5146/tjpath.2011.01065 |
An Unusual Case of Thyroid Papillary Carcinoma with Solitary Cerebral Metastasis Presenting with Neurological Symptoms |
Indranil CHAKRABARTI , Amita GIRI, Kaushik MAJUMDAR , Anuradha DE |
Department of Pathology, North Bengal Medical College, WEST BENGAL, INDIA |
Keywords: Brain, Papillary thyroid carcinoma, Metastasis |
|
|
Papillary carcinoma of the thyroid is well known for metastasis to
regional lymph nodes resulting in early detection and overall favorable
prognosis. Solitary metastasis of papillary carcinoma of the thyroid in
the cerebrum is extremely rare with only a few cases reported in the
literature. Here, we report an unusual case of a 40-year-old female
patient who presented with neurological symptoms and a radiological
diagnosis of meningioma was made. Subsequent histopathology from
the resected brain tumor revealed a solitary cerebral metastasis from
papillary carcinoma of the thyroid. There was no involvement of
regional lymph nodes and the radiological findings were indicative
of a primary brain tumor. |
|
|
|
Papillary carcinoma of the thyroid is the most common type
of thyroid tumor being slightly more common in women.
In general, papillary carcinoma of the thyroid appears to
have a good prognosis with involvement of regional lymph
nodes. Cases of distant metastasis of papillary carcinoma of
the thyroid have been reported mostly to the lung, bone and
liver. Evidently, the prognosis worsens with the presence
of a distant metastasis. Solitary metastasis to cerebrum is
extremely uncommon with only a few cases reported in the
literature. In various studies undertaken, a solitary cerebral
metastasis has been detected in only 0.4% to 1.2% of the
rare subgroup of papillary carcinomas in which distant
metastasis occurs and the brain appears to be as susceptible
as lungs or bones to be the first site of a distant metastasis 1. |
Top
Abstract
Introduction
Case Presentation
Disscussion
References
|
|
|
A 40-year-old woman presented to the outpatients
department with evidence of headache, disorientation,
drowsiness, vomiting and weakness in the left side of
the body for the last two weeks. She also suffered from
two episodes of convulsions during this period. Physical
examination revealed a small, 2 cm mass on the right side of
the neck which moved vertically on swallowing. The patient
was unaware of her neck lesion. An urgent CT scan was
advised which revealed a mass 5x3 cm on the right cerebral
hemisphere in the frontal region with intimate attachment
to the duramater (Figure 1). A radiological suggestion of
meningioma was made. Fine needle aspiration cytology
(FNAC) was done from the neck mass. Hematological and
biochemical examinations, including thyroid function test
and chest X-ray were performed.
Click Here to Zoom |
Figure 1: CT scan report showing a right frontal lobe space
occupying lesion (SOL) with attachment to the duramater. |
The space-occupying lesion in the brain was excised and
sent to the histopathology laboratory.
The hematological and biochemical parameters as well as
the chest X-ray did not reveal any abnormal findings. The
cytology smears obtained by fine needle aspiration done
from the neck swelling showed cytological features of
papillary carcinoma of the thyroid.
Gross examination of the resected brain tumor revealed a
6x4x3 cm mass. The cut section showed partly solid and
cystic areas. The cystic areas were chocolate brown in
color containing colloid-like material and small papillary
projections. The surrounding brain tissue could be
identified grossly.
Microscopy showed presence of papillae lined by follicular
cells with Orphan Annie eye nuclei showing characteristic
overlapping. There were few cells with intranuclear
inclusions and grooves. Some colloid filled follicles with
evidence of scalloping and abortive follicles were also seen
(Figures 2, 3). The surrounding brain parenchyma showed
evidence of reactive gliosis.
Click Here to Zoom |
Figure 2: Microphotograph showing brain tissue (left) with
metastatic deposits of papillary carcinoma of thyroid (right)
(H&E; x100). |
Click Here to Zoom |
Figure 3: Microphotograph showing metastatic deposits of
papillary carcinoma of thyroid at a higher magnification.
(H&E; x400). |
A histopathological diagnosis of metastatic deposit of
papillary carcinoma of the thyroid in the brain tissue was
made based on the gross and microscopic findings.
Neurological symptoms improved after surgery.
Total thyroidectomy was performed 3 weeks after the
craniotomy and the findings were confirmatory of papillary
carcinoma of the thyroid (Figure 4). No other site of
metastasis could be detected.
Click Here to Zoom |
Figure 4: Microphotograph showing papillary carcinoma of total
thyroidectomy specimen (left) separated from normal thyroid by
a capsule; (H&E; x400). Inset shows optically clear nuclei with
nuclear grooves (arrowhead). |
|
Top
Abstract
Introduction
Case Presentation
Disscussion
References
|
|
|
Distant metastases of papillary carcinoma of the thyroid
are very rare and signify a poor overall prognosis if present.
Solitary metastasis to the brain is even rarer with only a few
reported cases in the literature. In a series, McConahey et al.
reviewed 859 patients of papillary carcinoma of the thyroid
and 11 (1.3%) were identified as having cerebral metastases 2. The study conducted by Hoie et al. revealed that 91 of
731 patients with papillary carcinoma of the thyroid had
distant metastases and only nine of these patients (1.2%)
had brain metastases 3. On the other hand, secondaries in
brain are mainly from primary malignancies in the lungs,
breast, melanomas, bones and genitourinary tract and
very rarely from the thyroid. The present case presented
with neurological symptoms initially with no complaints
or symptoms relating to the primary lesion which she
was completely unaware of. Michie HR et al described a
case of occult primary papillary carcinoma of the thyroid
in which the patient presented with headache and visual
impairment 4. In our case, the radiological findings suggested a diagnosis of meningioma because of its location
and radiological findings. Likewise, in a patient described
by Ohta Y et al the radiological suspicion was that of a
cavernous angioma, suggesting a strong clinical suspicion
is warranted to clinch a diagnosis 5.
To conclude, we report a very rare case of papillary
carcinoma of thyroid with solitary cerebral metastasis
without involvement of regional lymph nodes in which
the patient presented with neurological symptoms and the
radiological findings were indicative of a primary brain
tumor. |
Top
Abstract
Introduction
Case Presentation
Discussion
References
|
|
|
1) Ota T, Bando Y, Hirai M, Tanaka N, Takabatake Y, Kasahara
Y, Fujisawa M: Papillary carcinoma of the thyroid with distant
metastases to the cerebrum: a case report. Jpn J Clin Oncol 2001,
31: 112-115 [ PubMed ]
2) McConahey WM, Hay ID, Woolner LB, van Heerden JA, Taylor
WF: Papillary thyroid cancer treated at the Mayo Clinic, 1946
through 1970: initial manifestations, pathologic findings, therapy,
and outcome. Mayo Clin Proc 1986, 61:978-996 [ PubMed ]
3) Hoie J, Stenwig AE, Kullmann G, Lindegaard M: Distant
metastases in papillary thyroid cancer. A review of 91 patients.
Cancer 1988, 61:1–6 [ PubMed ]
4) Michie HR, O'Bryan-Tear CG, Marsh H, Glazer G: Cerebral
metastases from occult papillary carcinoma of the thyroid. Br J
Surg 1987, 74:647 [ PubMed ]
5) Ohta Y, Chong JM: Solitary brain metastasis of thyroid papillary
carcinoma mimicking a cavernous angioma by MRI. No Shinkei
Geka 2009, 37:467-472 [ PubMed ] |
Top
Abstract
Introduction
Case Presentation
Discussion
References
|
|
|
|
|
)
)
)
)