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.     

Water-clear cell adenoma associated with primary hyperparathyroidism: report of a case

We report a case of water-clear cell adenoma associated with primary hyperparathyroidism. A 59-year-old woman with a history of renal stones and bone fracture was referred for investigation of hypercalcemia and an elevated serum parathyroid hormone level. Skeletal X-rays showed osteopenia and ultrasound showed enlarged tumors in both sides of the inferior thyroid region. Computed tomography demonstrated a tumor in the posterior aspect of the left thyroid lobe but no lesion in the right aspect of the neck. Grossly, we found a 500 mg left lower parathyroid gland (PTG) and a 100 mg right lower PTG. Histologically, the left lower PTG comprised mainly water-clear cells (WCCs) containing numerous vacuoles. Chief cells were dispersed among the WCCs, but the right lower PTG showed normal parathyroid tissue. Several investigators have speculated that WCCs are derived from chief cells, and we diagnosed WCC adenoma. Following this case report, we review the relevant literature.     

Use of positron emission tomography in spindle cell carcinoma of the penis

A 60-year-old man presented with spindle cell carcinoma of the penis. He underwent surgery and additional positron emission tomography and computed tomography scans to evaluate for possible metastases. Positron emission tomography showed a left inguinal and paravesical hot spot on the right. Only the left inguinal lesion could be confirmed on computed tomography. The patient underwent additional surgery with curative intent. Three months later, the patient underwent repeat computed tomography, which revealed an osteolytic process in the right acetabulum. This lesion corresponded with the right paravesical hot spot on the positron emission tomography scan 3 months earlier.     

Solitary Brain Metastasis from Papillary Thyroid Carcinoma in a Patient with Depression: Report of a Case

Papillary carcinoma of the thyroid is a common thyroid malignancy with a relatively good prognosis. However, distant metastases may develop and become threatening, particularly to older patients, in a more aggressive manner. We report herein the clinical, radiological, and pathological findings of a patient with papillary thyroid carcinoma who had a solitary cerebral metastasis. The patient had been suffering from depression and had already undergone a hemithyroidectomy for primary thyroid carcinoma, and was known to have metastatic thryoid carcinoma of the lungs and bone. After the removal of the remnant thyroid gland prior to radioiodine (¹³¹I) therapy, he developed additional problems related to depression. Electroencephalography played an important role in identifying suspected brain metastasis and computed tomography demonstrated a space-occupying lesion in the left cerebral hemisphere. Consequently, an early removal of intracranial mass could be performed without any further life-threatening complications. Moreover, after removal of the brain mass the patient's depression improved immediately without the use of any antidepressants. This case report indicates the possibility that a patient's depression might be associated with brain metastasis from papillary thyroid carcinoma, and also suggests that an early diagnosis with the appropriate surgical management of a brain metastasis followed by radioiodine therapy could be valuable for achieving a prolonged disease-free period. Received: August 17, 1999 / Accepted: March 24, 2000     

Renal metastasis of thyroid carcinoma

We report here the sixth known case of metastatic renal tumor of thyroid carcinoma. In 1999, a 37-year-old man was referred to us with a left renal mass found incidentally by ultrasound during an annual check-up. Computed tomography (CT) revealed a well-defined, hyperdense mass 3 cm in diameter in the middle of the left kidney. Left radical nephrectomy was performed under the preoperative diagnosis of renal cell carcinoma. Histologically, the tumor was metastatic of typical papillary thyroid carcinoma.     

Breast Tumor Resembling the Tall Cell Variant of Papillary Thyroid Carcinoma

Abstract:  We describe the case of a 66-year-old woman with a palpable mass in her left breast. Although the diagnosis on core biopsy was an intraductal papilloma, the surgically excised lesion showed it to be an infiltrating carcinoma which appeared to arise in a complex sclerosing lesion and is similar to the recently described breast tumor resembling the tall cell variant of papillary thyroid carcinoma.     

A case of multiple occult thyroid cancers with tracheal stenosis by invasion from metastatic lymph node

A 59-old woman visited to our hospital with complaint of uttering stenotic sound at expiratory stage. Her chest X-ray film showed a suspicious intratracheal tumor, which was arising from the left side of the tracheal wall and confirmed 4 cm from the vocal cord by bronchofiber scope. The biopsy specimens showed well differentiated papillary adenocarcinoma. The lesion was judged to be a intrathoracic thyroid carcinoma and to infiltrate the trachea. Her air way failed to be ensured with YAG-LASER. Therefore, a subemergency operation was done. The intrathoracic lesion had no sequence of the thyroid gland. Two occult thyroid carcinomas were intraoperatively discovered. She underwent total thyroidectomy and sleeve trachectomy whose anastomosis was wrapped up in an omental flap. The intraluminal part of the tumor histologically showed poorly differentiated carcinoma, in contrast to the extratracheal part of the tumor showing well differentiated carcinoma. She was treated with radioactive iodine due to her positive 131I scintigraphy. Nine months later, a very similar lesion newly developed at the left side of trachea and made same symptoms.     

Colloid (enterogenous) cyst in the frontal lobe

A 60-year-old man presented with a left frontal mass lesion incidentally detected at a health check without apparent symptoms. Computed tomography revealed the lesion as homogeneous high density and magnetic resonance (MR) imaging showed the lesion as hyperintense on T(1)-weighted images, isointense on T(2)-weighted images, and hypointense on diffusion-weighted images. T(1)-weighted MR images with gadolinium showed no enhancement of the mass lesion. Cerebral angiography revealed an avascular area around the left frontal lesion. Total removal of the lesion was achieved through a craniotomy without complications. Histological, immunohistochemical, and electron microscopy examinations established the definite diagnosis of colloid cyst.     

Skull metastasis from thyroid follicular carcinoma with difficult diagnosis of the primary lesion

A 57-year-old male patient presented with an immobile ellipsoid mass of 6-cm diameter in the right occipitoparietal region. Cranial computed tomography showed the mass with dense contrast enhancement causing bone destruction. After embolization of the mass, total resection was performed. Histological examination showed the mass had a capsule, with no invasion of the dura mater or dermis, and the follicles of various sizes covered with mono-lined thyrocytes were full of colloid. Immunohistochemical examination showed positive staining for thyroglobulin. Postoperatively, levels of thyroid hormones were normal, and thyroid ultrasonography and technetium-99m scintigraphy showed no abnormalities. Fine needle aspiration biopsy performed at various locations of the thyroid gland revealed no atypical thyroid cells. Whole body technetium-99m scintigraphy found no abnormal bone involvement. The histological evidence was suggestive of follicular carcinoma metastasis. Surgical treatment was planned for the thyroid gland, but the patient did not consent. Two years later, the patient presented with the pain and sensitivity in the sacrum, the right iliac wing, and the right caput femoris. Computed tomography revealed lytic lesions in these areas. Bone metastases were identified. Whole body scintigraphy showed increased activity in these regions, but the cranium and all other tissues were normal. The patient underwent total thyroidectomy under a diagnosis of follicular carcinoma. The present case of a lytic skull lesion associated with normal thyroid tissue on admission but finally treated as follicular thyroid cancer emphasizes the difficulty in histological discrimination of follicular carcinoma from normal thyroid tissue.     

A unique presentation of ectopic thyroid,a case report

IntroductionThis case presents a painful ectopic thyroid, an unusual presentation, in an atypical location. The patient’s history of an ingested fish bone, her acute presentation, and inconclusive imaging, made this case a diagnostic dilemma.Presentation of case61-year-old female presented with acutely worsening history of left throat pain and dysphagia after swallowing a fish bone. CT scan showed a foreign body in the anterior wall of the cervical esophagus. EGD studies were inconclusive. Surgical exploration identified and excised a multinodular cystic lesion without connection to esophageal lumen. Pathology described multinodular thyroid parenchyma with chronic inflammation and no evidence of malignancy. No foreign body was located.DiscussionBased on the patient’s history, imaging, and acute presentation, an esophageal perforation with abscess formation was the most likely diagnosis. Surgical exploration was the necessary intervention for this patient’s acute symptoms as both a diagnostic and therapeutic tool. The diagnosis of ectopic thyroid tissue from pathology of the excised cystic lesion was unexpected, as the location of tissue and the painful presentation are not typical characteristics of ectopic thyroid tissue. Management of the this case illustrates the dilemma faced in determining the appropriate work up for a patient, without compromising the patient’s safety.ConclusionThough painful presentation and this case’s location are rare, ectopic thyroid tissue should be included in the differential diagnosis of point tenderness with an associated lesion on imaging.     

Primary hyperparathyroidism with thyroid hemiagenesis

Thyroid hemiagenesis is a very rare anomaly. We herein report a case with right thyroid lobe agenesis, which was incidentally found during the assessment of primary hyperparathyroidism. A 42-year-old male presenting with urinary lithiasis was suspected of having primary hyperparathyroidism, and had elevated levels of both serum calcium and intact parathyroid hormone. Both computed tomography and ultrasonography demonstrated the absence of right thyroid lobe and a mass of 1 cm in diameter at the left lower pole of the thyroid. The patient underwent lower left parathyroidectomy, which confirmed the right thyroid hemiagenesis, as well as the absence of both upper and lower right parathyroid glands. The resected left lower parathyroid gland was pathologically diagnosed as adenoma. The postoperative course was favourable and he was discharged on the 2nd day after surgery, without complications.     

A case of bilateral intrathyroidal branchial cleft cyst in a newborn

We describe an extremely rare case of bilateral intrathyroidal branchial cleft cysts. A 2-day-old male neonate presented with intermittent tachypnea, dyspnea, and a palpable neck mass. Cervical ultrasonography and computerized tomography scan demonstrated a right-sided 3 × 3-cm cystic mass and a left sided 4.5 × 4-cm cystic mass, thought to be originating in the thyroid gland. The right-sided cyst decreased in size after OK-432 sclerotherapy. The left-sided cyst showed little response to 2 attempts of OK-432 sclerotherapy. Surgical removal of the left-sided cyst was done because of intermittent airway problems. The cystic mass was thought to be an intrathyroidal lesion. Microscopically, the cyst was lined by nonkeratinized squamous epithelium and respiratory epithelium. Lymphocyte infiltration was found in the subepithelial layer. The patient is currently doing well 12 months later with no evidence of recurrence.     

Mediastinal goiter; report of a case

A 76-year-old female was admitted to our hospital because of an abnormal shadow on chest computed tomography (CT) which showed the tumor extending from left lower end of the thyroid to the aortic window along the left side of the trachea, indicating the retrosternal goiter. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were within normal ranges. The tumor was resected through cervical collar incision and median sternotomy. The pathological diagnosis was an adenomatous goiter. The patient was discharged without complications.     

Surgical reconstruction of the common carotid artery by an ePTFE graft for invasive thyroid cancer: a case report

Surgical reconstruction of the carotid artery using a synthetic graft is rarely performed. A 71-year-old woman developed hoarseness and was diagnosed as having thyroid cancer. Computed tomography (CT) and angiography revealed an irregular thyroid tumor invading the left common carotid artery, and encasement of the artery by the tumor. Left common carotid angiography showed an irregularity of the common carotid artery wall and a dense tumor stain fed by the superior thyroid artery. Dissection of the thyroid cancer from the common carotid artery was judged to be impossible during surgery, so resection of the whole tumor together with the common carotid artery was carried out. The left common carotid artery was reconstructed using an expanded polytetrafluoroethylene (ePTFE) graft. No cerebral ischemia was evident after surgery. Postoperative CT and magnetic resonance angiography demonstrated patency of the carotid artery, and no tumor recurrence was confirmed at a 27-month follow up. The ePTFE graft appears to be a suitable synthetic graft for reconstruction of the carotid artery.     

Inflammatory myofibroblastic tumor of the lung- a case report

A 45-year-old man presented with a six-month history of progressive dyspnea with productive cough and wheezing. The patient was a heavy smoker and had a history of tongue cancer, hypertension, and asthma. Chest X-ray and computed tomography showed a mass lesion in the left hilar region and total collapse of the upper left lobe of the lung. Bronchoscopy revealed a whitish solid tumor obstructing the left upper lobe bronchus. Positron emission tomography showed increased tracer uptake in the lesion. A thoracoscopic lobectomy of the left upper lobe of the lung was performed. The final pathologic diagnosis was inflammatory myofibroblastic tumor.     

A case of meningioangiomatosis in an infant

We report here a rare case of meningioangiomatosis in an infant, not associated with von Recklinghausen's disease. A 14-month-old female was admitted because of seizures. Neurological findings on admission were normal. Computed tomography showed a slightly high density mass with marked contrast enhancement in the left temporoparietal lobe. Magnetic resonance image (MRI) revealed a slightly hypointensive lesion surrounded by an isointensive band on T1-weighted image, and a hyperintensive lesion surrounded by a slightly hypointensive band on T2-weighted image. Brain edema was shown to a certain extent around the lesion on MRI. Left carotid angiography demonstrated a slightly upward shift of the left middle cerebral artery, but no abnormal vascularity was shown. A temporoparietal craniotomy was performed. A yellowish red, elastic soft tumor was observed in the left temporal lobe. The tumor resembled hyperemic hypertrophic gyri and was well demarcated. Total removal of the tumor was performed. Pathological diagnosis was meningioangiomatosis. The patient is still doing well 3 years and 5 months after the operation. There was no evidence of recurrence on computed tomography at the 3-year follow up. She didn't have any stigmata, such as café au lait spots or neurofibromas suggesting von Recklinghausen's disease.     

Metastasis of thyroid cancer to primary lung cancer

We present a case of a 65-year-old woman whose thyroid cancer metastasized to the lesion of primary lung cancer. Ten years after total thyroidectomy for thyroid cancer, chest radiograph by medical checkup demonstrated three nodular lesions in the bilateral lung fields. Segmental resection of the left S6, partial resection of right S4 and left S10 were performed to remove those lesions. Histologically, small nodules in the right S4 and S10 were diagnosed as a metastatic tumor of thyroid and well differentiated adenocarcinoma, respectively. Left S6 lesion 1.5 cm in diameter was also diagnosed as well-differentiated adenocarcinoma (Noguchi type C), however, small metastatic foci of papillary adenocarcinoma was identified within the lesion which revealed to be “cancer in cancer metastasis”. Metastasis of cancer to another primary cancer is a rare event. We discuss interesting phenomenon of cancer in cancer metastasis with a review of the literature.     

Metastatic sternal tumor from thyroid papillary carcinoma; report of a case

A 68-year-old male was referred to our department for treatment of a metastatic sternal tumor in the manubrium sterni. Primary lesion was papillary carcinoma of the left lobe of the thyroid gland. Total thyroidectomy, cervical lymph node dissection, resection of manubrium sterni with concomitant resection of bilateral clavicles, 1st ribs and 2nd ribs, and chest wall reconstruction using Marlex Mesh were performed on January 29, 2001. Considering relatively good prognosis and good response to multimodality therapy, surgical resection of sternal metastatic lesion from differentiated thyroid cancer seems to be a choice of therapy as a part of multimodality approach, including surgery, radioiodine and external radiation therapy, to thyroid cancer with systemic spread.     

Metastatic lung tumor from colon cancer with cavitation: report of a case

A 55-year-old man underwent rectal amputation for rectal cancer in August 2005. A tiny thin-walled cavity lesion in his left S1+2 was found on computed tomography (CT) of the chest in November 2008. The cavity lesion in the left S1+2 gradually increased in size over 3 months and positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) showed FDG accumulation at the lesion. Videoassisted thoracoscopic (VATS) wedge resection was performed to make a definite diagnosis in March 2009. The pathological findings revealed a metastatic lung tumor from the rectal cancer. It is necessary to consider the possibility of metastatic lung tumors in a case with the cavity lesions especially in patients with a history of colon cancer.