1
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Huq S, Shanahan RM, Adida S, Bin-Alamer O, Abou-Al-Shaar H, Niranjan A, Hadjipanayis CG, Lunsford LD. Gamma knife radiosurgery for clival metastasis: case series and systematic review. J Neurooncol 2024; 168:171-183. [PMID: 38598088 DOI: 10.1007/s11060-024-04648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis. METHODS Records of 14 patients with clival metastasis who underwent GKRS at the University of Pittsburgh Medical Center from 2002 to 2023 were reviewed. Treatment parameters and clinical outcomes were assessed. A systematic review was conducted using evidence-based guidelines. RESULTS The average age was 61 years with male predominance (n = 10) and average follow-up of 12.4 months. The most common primary cancers were prostate (n = 3) and lung (n = 3). The average time from cancer diagnosis to clival metastasis was 34 months. The most common presenting symptoms were headache (n = 9) and diplopia (n = 7). Five patients presented with abducens nerve palsies, and two presented with oculomotor nerve palsies. The median tumor volume was 9.3 cc, and the median margin dose was 15 Gy. Eleven patients achieved tumor control after one procedure, and three with progression obtained tumor control after repeat GKRS. One patient recovered abducens nerve function. The median survival from cancer diagnosis and GKRS were 49.7 and 15.3 months, respectively. The cause of death was progression of systemic cancer in six patients, clival metastasis in one, and unknown in four. The systematic review included 31 studies with heterogeneous descriptions of treatment and outcomes. CONCLUSION Clival metastasis is rare and associated with poor prognosis. GKRS is a safe, effective treatment for clival metastasis.
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Affiliation(s)
- Sakibul Huq
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA.
| | - Regan M Shanahan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Samuel Adida
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - Constantinos G Hadjipanayis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Suite B-400, 15213, Pittsburgh, PA, USA
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2
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Carretta A, Sollini G, Guaraldi F, Rustici A, Magnani M, Asioli S, Faustini-Fustini M, Pasquini E, Zoli M, Mazzatenta D. Clival Metastases: Single-Center Retrospective Case Series and Literature Review. J Clin Med 2024; 13:2580. [PMID: 38731109 PMCID: PMC11084723 DOI: 10.3390/jcm13092580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk-benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers.
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Affiliation(s)
- Alessandro Carretta
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, 40138 Bologna, Italy; (A.C.); (S.A.); (M.Z.); (D.M.)
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (M.F.-F.)
| | - Giacomo Sollini
- ENT Unit, Bellaria Hospital, Azienda USL Bologna, 40139 Bologna, Italy; (G.S.); (E.P.)
| | - Federica Guaraldi
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (M.F.-F.)
| | - Arianna Rustici
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore, 40139 Bologna, Italy;
| | - Marcello Magnani
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, 40138 Bologna, Italy; (A.C.); (S.A.); (M.Z.); (D.M.)
| | - Sofia Asioli
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, 40138 Bologna, Italy; (A.C.); (S.A.); (M.Z.); (D.M.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Faustini-Fustini
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (M.F.-F.)
| | - Ernesto Pasquini
- ENT Unit, Bellaria Hospital, Azienda USL Bologna, 40139 Bologna, Italy; (G.S.); (E.P.)
| | - Matteo Zoli
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, 40138 Bologna, Italy; (A.C.); (S.A.); (M.Z.); (D.M.)
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (M.F.-F.)
| | - Diego Mazzatenta
- Department of Bio-Medical and Neuromotor Sciences (DIBINEM), University of Bologna, 40138 Bologna, Italy; (A.C.); (S.A.); (M.Z.); (D.M.)
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (M.F.-F.)
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3
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Chaudhry H, Sohal A, Iqbal H, Chaudhary U, Roytman M. Unusual sites of hepatocellular carcinoma metastasis: Case report. SAGE Open Med Case Rep 2023; 11:2050313X231211709. [PMID: 38022862 PMCID: PMC10647942 DOI: 10.1177/2050313x231211709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Hepatocellular carcinoma is an increasingly frequent cause of cancer-related death. The majority of patients with hepatocellular carcinoma are asymptomatic. In rare cases, patients may present with symptoms of extrahepatic metastases. Early identification can lead to timely treatment and prevent poor outcomes. We report three cases of patients with hepatocellular carcinoma with unusual sites of metastasis, including clival, mandible, and cardiac involvement.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco—Fresno, Fresno, CA, USA
| | | | - Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco—Fresno, Fresno, CA, USA
| | - Uzair Chaudhary
- Department of Hematology and Oncology, University of California San Francisco—Fresno, Fresno, CA, USA
| | - Marina Roytman
- Division of Gastroenterology, Hepatology and Nutrition, University of California San Francisco—Fresno, Fresno, CA, USA
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4
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Baier MP, Cheong DA, Shi HH, Peterson JEG, Fung KM, Dunn IF, McKinney KA, Graffeo CS. Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example. J Neurol Surg Rep 2023; 84:e156-e162. [PMID: 38124781 PMCID: PMC10733071 DOI: 10.1055/a-2215-0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Clival tumors are rare and heterogeneous. Although some benign prototypical sellar lesions may present as clival tumors, the likelihood of malignant disease is higher. Here we define a novel algorithm for the workup and management of clival masses through an illustrative case of colorectal adenocarcinoma metastasis to the clivus. Methods In this case report, the best practice guidelines for managing clival masses are described through a literature review and refined by senior author consensus. We conducted a focused systematic review to characterize the present case in the context of clival metastasis from gastrointestinal malignancy. Results An 83-year-old woman presented with 4 weeks of headaches and blurry vision. Examination revealed partial right abducens and left oculomotor palsies. Magnetic resonance imaging (MRI) identified a large, weakly enhancing sellar and clival mass with sphenoid sinus extension. An aggressive subtotal endoscopic endonasal resection was performed with removal of all sphenoid, clival, and sellar disease without cavernous sinus wall resection. Pathology confirmed colorectal adenocarcinoma; computed tomography (CT) imaging identified an ascending colon mass with metastases to the liver and mesenteric nodes. Palliative oncologic therapies were recommended, but she elected hospice, and died 3 months after initial presentation. Gastrointestinal clival metastases are exceedingly rare among sellar and clival pathologies, with eight prior cases reported, most of which presented with diplopia from abducens nerve involvement. Conclusion Clival masses are uncommon skull base lesions that are associated with more aggressive diseases. We present a consolidated framework for decision-making in these challenging patients, alongside an unusual case example that illustrates the importance of increased suspicion for malignant clinical entities in this setting.
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Affiliation(s)
- Matthew P. Baier
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Daniel A. Cheong
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Helen H. Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Jo Elle G. Peterson
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Ian F. Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Kibwei A. McKinney
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Christopher S. Graffeo
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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5
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Palsetia DR, Vijan AV, Gala FB, Sahu AC, Patkar DP, A. AS. Clival and Paraclival Lesions: A Pictorial Review. Indian J Radiol Imaging 2023; 33:201-217. [PMID: 37123565 PMCID: PMC10132890 DOI: 10.1055/s-0043-1761183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
AbstractThe clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which typically affect the clivus because of its strategic location and embryological origins. Clival lesions may often be asymptomatic with occasional complaints like headache or cranial neuropathy in few. Cross-sectional imaging techniques, namely, computed tomographic scan and magnetic resonance imaging, thus, play a key role in approximating to the final diagnosis and estimating the disease extent. In this article, we highlight the important imaging features of various clival and paraclival pathologies to facilitate effective diagnosis, therapeutic planning, and management.
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Affiliation(s)
- Delnaz R. Palsetia
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Antariksh V. Vijan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Foram B. Gala
- Department of Radiodiagnosis and Imaging, Lifescan Imaging Centre & Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Amit C. Sahu
- Department of Interventional Neuro-Radiology, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Deepak P. Patkar
- Department of Imaging, Nanavati Superspecialty Hospital, Mumbai, Maharashtra, India
| | - Arpita Sahu A.
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Çelik A, Özdoğan S. Evaluation of diplopia as a vital and remarkable ocular finding among cancer patients. Ir J Med Sci 2022:10.1007/s11845-022-03177-6. [PMID: 36323928 DOI: 10.1007/s11845-022-03177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Diplopia is an important and debilitating symptom of malignancies due to different pathogenetic mechanisms. Data is lacking in the literature because of the rarity of the diplopia in patients with cancer. AIMS We aimed to evaluate the etiological and clinical factors of diplopia in patients with different types of cancer. METHODS We retrospectively investigated 22 cancer patients with diplopia who were admitted between 2018 and 2021. The diagnosis of primary cancer, the underlying factors causing diplopia, and the life expectancy after diplopia were evaluated. RESULTS Among available data of 620 cancer patients applied to our ophthalmology department, 22 (3.55%) had diplopia. Paralytic strabismus was found in 19 patients and restrictive strabismus was found in 3 patients. Among the paralytic cases, 6th nerve palsy was found to be the most common with a rate of 68%. In 18 of 22 (82%) patients, the cause of diplopia was due to orbital or brain metastasis or local invasion. Two patients had diplopia secondary to radiotherapy and 2 had diplopia due to chemotherapy. CONCLUSION Metastasis is the most common cause of diplopia in patients with cancer and screening for metastasis is crucial as soon as diplopia begins for a better life expectancy.
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Affiliation(s)
- Ayşenur Çelik
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Sibel Özdoğan
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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7
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Yang CM. Metastasis of Follicular Thyroid Carcinoma to Skull Base: A Case Report. Cureus 2022; 14:e28571. [PMID: 36185905 PMCID: PMC9520636 DOI: 10.7759/cureus.28571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
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8
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Nardi C, Maraghelli D, Pietragalla M, Scola E, Locatello LG, Maggiore G, Gallo O, Bartolucci M. A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus. Neuroradiology 2022; 64:1483-1509. [PMID: 35657394 PMCID: PMC9271108 DOI: 10.1007/s00234-022-02986-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird’s-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.
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Affiliation(s)
- Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Elisa Scola
- Department of Neuroradiology, Careggi University Hospital, Largo Piero Palagi 1, 50134, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Maurizio Bartolucci
- Department of Radiology, Azienda USL Toscana Centro, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20/22, 59100, Prato, Italy
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9
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Jozsa F, Das JM. Metastatic Lesions of the Clivus: A Systematic Review. World Neurosurg 2021; 158:190-204. [PMID: 34861450 DOI: 10.1016/j.wneu.2021.11.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Metastatic lesions of the clivus are extremely rare, having previously been estimated as representing 0.02% of all intracranial tumors. Owing to its close intracranial relationship with the clivus before entering the cavernous sinus, clinical palsies of the sixth cranial nerve have been classically associated with destructive lesions of this structure. METHODS A comprehensive search of PubMed was conducted for studies of patients with metastasis to the clivus from primary cancer at any site. Studies reported in English in the past 20 years from our last search on April 12, 2021 were included. The data collected included patient age, sex, symptoms at presentation, histopathology and treatment timeline of the primary tumor, treatment, follow-up, and mortality. RESULTS After the literature review, 46 studies reporting on 58 patients with clivus metastasis were included in the final analysis. The mean age of the patients was 57.5 years, and 39 were male (67.2%). The most common sites of the primary tumor were the prostate (22%), gastrointestinal tract (15%), lung (13%), and kidney (11%). In 43% of patients, symptoms of clivus metastasis had presented before the diagnosis of primary cancer was known, and 71% of the patients had presented with sixth nerve palsy. Of the 58 patients, 53% had undergone surgery, and 37% had received adjuvant radiotherapy. Of the 58 patients, 25% had received radiotherapy alone. The endoscopic transsphenoidal approach to the clivus was almost uniquely used for surgical management. Survival data were available for 31 patients. Death had occurred at a mean of 9.4 months after the presentation of clivus metastasis. A strong correlation was found between the interval from primary cancer to the presentation of clivus metastasis and mortality. CONCLUSIONS Although an extremely rare occurrence, clivus metastasis should be considered in patients with a history of malignancy, in particular, prostate malignancy, presenting with new-onset isolated sixth nerve palsy.
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Affiliation(s)
- Felix Jozsa
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Joe M Das
- Department of Neurosurgery, Bahrain Specialist Hospital, Juffair, Bahrain
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Abstract
Due to the aggressive nature of hepatocellular carcinoma (HCC), most patients succumb to disease before any distant metastasis, such as to the central nervous system (CNS), can occur. Thus only a handful of cases of metastasis to the skull base have been described. After a thorough review of the available literature published since 1950, we report the sixth case of HCC metastasis to the clivus. In this case, a 65-year-old man with a history of melanoma presented with sudden onset of right-sided headache and complete ophthalmoplegia of the right eye for one month. MRI of the brain with and without contrast demonstrated a homogeneously enhancing lesion involving the clivus with evidence of invasion into the right cavernous sinus. Through further body imaging, he was found to have an infiltrative lesion in the left hepatic lobe and underwent an ultrasound-guided biopsy of said lesion that was proven to be well-differentiated hepatocellular carcinoma. An endonasal endoscopic biopsy of his clival lesion was performed and the final pathology was consistent with a metastatic HCC. This case demonstrates the impact of obtaining a surgical specimen of clival tumors to confirm the suspected diagnosis, as well as to perform molecular studies that can drive post-operative decision-making and prognosis. As in this case, the final diagnosis altered treatment plans from that of melanoma, with systemic chemotherapy and radiosurgery, to stereotactic radiosurgery and intrahepatic radioembolization.
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Affiliation(s)
| | - Yasir R Khan
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Danny Blais
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Bandana Mahato
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
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Kim H, Kim JH, Lee K, Kim TH. Incidentally-Discovered Extraosseous Cystic Nasopharyngeal Chordoma in a Papillary Thyroid Cancer Patient. JOURNAL OF RHINOLOGY 2019. [DOI: 10.18787/jr.2019.26.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hyunjung Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Jae Hyung Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Kijeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul, Korea
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12
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Gomes JPP, Veloso JDRC, Altemani AMDAM, Chone CT, Altemani JMC, de Freitas CF, Lima CSP, Braz-Silva PH, Costa ALF. Three-Dimensional Volume Imaging to Increase the Accuracy of Surgical Management in a Case of Recurrent Chordoma of the Clivus. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1168-1174. [PMID: 30275439 PMCID: PMC6180943 DOI: 10.12659/ajcr.911592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient: Male, 53 Final Diagnosis: Clivus chordoma Symptoms: Pain the eye Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- João Pedro Perez Gomes
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of Sao Paulo (USP), São Paulo, SP, Brazil
| | - José de Ribamar Castro Veloso
- Department of Orthodontics and Radiology, School of Dentistry, University City of São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Carlos Takahiro Chone
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Claudio Fróes de Freitas
- Department of Orthodontics and Radiology, School of Dentistry, University City of São Paulo (UNICID), São Paulo, SP, Brazil
| | - Carmen Silvia Passos Lima
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Andre Luiz Ferreira Costa
- Department of Orthodontics and Radiology, School of Dentistry, University City of São Paulo (UNICID), São Paulo, SP, Brazil
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13
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Zhang WQ, Bao Y, Qiu B, Wang Y, Li ZP, Wang YB. Clival metastasis of renal clear cell carcinoma: Case report and literature review. World J Clin Cases 2018; 6:301-307. [PMID: 30211212 PMCID: PMC6134277 DOI: 10.12998/wjcc.v6.i9.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/07/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023] Open
Abstract
The clivus is an atypical metastatic site for renal clear cell carcinoma (RCCC). Here we report a 54 year old man with acute cavernous sinus syndrome. Brain magnetic resonance imaging identified a clival-based lesion with associated bony erosion. The patient underwent endoscopic endonasal biopsy and partial resection of the clival mass. Because histologic examination of the resected specimen resulted in a diagnosis of RCCC, contrast-enhanced computed tomography scan of the abdomen was performed and showed an enhanced left renal mass. The patient subsequently underwent laparoscopic left radical nephrectomy and gamma knife was planned for the residual clival lesion. We also retrospectively reviewed available published reports on clival metastases, specifically those from RCCC, since 1990.
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Affiliation(s)
- Wei-Qi Zhang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yue Bao
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bo Qiu
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yong Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi-Peng Li
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yi-Bao Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Scotto di Carlo F, Divisato G, Iacoangeli M, Esposito T, Gianfrancesco F. The identification of H3F3A mutation in giant cell tumour of the clivus and the histological diagnostic algorithm of other clival lesions permit the differential diagnosis in this location. BMC Cancer 2018; 18:358. [PMID: 29609578 PMCID: PMC5880014 DOI: 10.1186/s12885-018-4291-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant Cell Tumour of Bone (GCT) is a locally aggressive primary bone tumour that usually occurs at the epiphyses of the long bones of the appendicular skeleton with a tendency to recurrence. Recurrent somatic H3F3A mutations have been described in 92% of GCT cases. GCTs involving the Clivus are extremely rare lesions and less than 15 cases are described in the literature. They represent a surgery challenge and are easily misdiagnosed. Our aim was to reveal if the genetic bases underlying Clival GCTs were the same of GCTs of long bones to improve the diagnosis and treatment. METHODS The targeted somatic sequencing of GCT-related genes (H3F3A, H3F3B, IDH1, IDH2 and ZNF687) was performed on Clival GCT biopsies of two different cases. Histological analyses on the same tissues were used to detect the neoplastic population and its expression profile. RESULTS Sanger sequencing revealed that both patients were positive for the p.Gly34Trp mutation in the H3F3A gene. Immunofluorescence assay using monoclonal antibody, specifically detecting the mutant H3.3, highlighted that the mutation only involved the mononuclear cell population and not the multinucleated giant cells. Moreover, immunohistochemistry assay showed that RANKL was highly expressed by the stromal cells within Clival GCT, mimicking what happens in GCT of the long bones. In addition, systematic literature review allowed us to generate a histology-based diagnostic algorithm of the most common clival lesions. CONCLUSIONS We conclude that the Clival GCT is genetically defined by somatic mutation in the H3F3A gene, linking it to the GCT of long bones. The similarity with GCTs of long bones let us to hypothesize the utility of Denosumab therapy (already effective for GCTs) in these surgically challenging cases. Moreover, H3F3A genetic screening can be combined to the histological analysis to differentiate GCTs from morphologically similar giant cell-rich sarcomas, while the histological diagnostic algorithm could help the differential diagnosis of other clival lesions.
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Affiliation(s)
- Federica Scotto di Carlo
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", National Research Council of Italy, Naples, Italy.,Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Giuseppina Divisato
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", National Research Council of Italy, Naples, Italy
| | | | - Teresa Esposito
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", National Research Council of Italy, Naples, Italy.,IRCCS INM Neuromed, Pozzilli, Italy
| | - Fernando Gianfrancesco
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", National Research Council of Italy, Naples, Italy.
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15
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Lee C, Thon JM, Dhand A. Clival metastasis from a gastrointestinal adenocarcinoma causing multiple cranial neuropathies. BMJ Case Rep 2017; 2017:bcr-2017-222725. [PMID: 29122907 DOI: 10.1136/bcr-2017-222725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 78-year-old man with a history of benign prostatic hyperplasia presented with double vision, facial pain, altered taste and headache for 7 weeks. Neurological exam was notable for palsies of the right V, VI, VII and XII cranial nerves. An expansive clival mass and multiple lesions in the vertebra were found on MRI. Radionuclide studies showed extensive tumour burden in his liver and peritoneum. His serologies showed normal carcinoembryonic antigen and carbohydrate antigen 19-9 levels and modestly elevated prostate-specific antigen, which was a red herring. Biopsy of his omentum was consistent with metastatic adenocarcinoma with immunostaining indicating an upper gastrointestinal primary tumour. The patient underwent several cycles of radiation therapy, but ultimately elected to pursue hospice care. This case demonstrates the presentation of multiple cranial neuropathies from a clival mass and an unusual primary source from an upper gastrointestinal tumour.
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Affiliation(s)
| | - Jesse M Thon
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amar Dhand
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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16
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Folbe AJ, Svider PF, Liu JK, Eloy JA. Endoscopic Resection of Clival Malignancies. Otolaryngol Clin North Am 2017; 50:315-329. [PMID: 28314400 DOI: 10.1016/j.otc.2016.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Surgical management of clival lesions presents numerous therapeutic challenges because of the close proximity of surrounding critical structures. With a detailed understanding of the endoscopic endonasal approach and relevant considerations, appropriate lesions can be removed in a safe and minimally invasive manner. Use of this technique as a primary approach represents the standard of care for many lesions at leading skull base centers, although adjunct techniques may be necessary in extensive lesions and those with significant lateral extension.
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Affiliation(s)
- Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA; Department of Neurosurgery, Wayne State University School of Medicine, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, USA.
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Endoscopic Skull Base Surgery Program, Rhinology and Sinus Surgery, Otolaryngology Research, Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
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17
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Mani A, Yadav P, Paliwal VK, Lal H. Isolated clival metastasis: a rare presentation of renal cell carcinoma. BMJ Case Rep 2017; 2017:bcr-2017-221570. [PMID: 28801336 DOI: 10.1136/bcr-2017-221570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal cell carcinoma accounts for 3% of all adult malignancies. Usual sites of metastasis are lymph nodes, lungs, bone, liver and brain. We describe a patient who presented with complaints of holocranial headache and diplopia. MRI of the head showed a clival-based lesion with associated bony erosion. With suspicion of a metastatic lesion, an ultrasonogram of the abdomen was done which showed a left renal mass that enhanced on contrast-enhanced CT. There were no other metastatic foci. Patient underwent radiotherapy for the clival lesion. This case report emphasises on the evaluation of clival lesion with cranial neuropathies for a possibility of a renal primary tumour.
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Affiliation(s)
- Anil Mani
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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18
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Machío Castelló M, Escobar Montatixe D, Cenjor Español C, Villacampa Aubá JM, Montoya Bordón J, Carias Calix R, Sáez Pinel R. Incomplete cavernous sinus syndrome as the initial manifestation of a previously undetected metastatic prostate adenocarcinoma. Head Neck 2017; 39:E77-E80. [PMID: 28474478 DOI: 10.1002/hed.24808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/14/2017] [Accepted: 03/14/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cavernous sinus syndrome presents as unilateral ophthalmoplegia associated with sympathetic denervation, pain, paresthesias, and V1 and V2 distribution numbness. The etiology may be vascular, inflammatory, infectious, and, less commonly, neoplastic (metastatic). METHODS We report a patient with incomplete cavernous sinus syndrome as the initial manifestation of previously undetected metastatic prostate adenocarcinoma. RESULTS A 59-year-old man presented with a 2-month history of left hemicranial headaches with ptosis and binocular diplopia. Clinical evaluation found left third, fourth, and sixth cranial nerve palsy with mydriasis and ptosis. An MRI showed an enhancing lesion at the clivus with infiltration of left cavernous sinus. A trans-sphenoidal biopsy was performed, leading to diagnosis of metastatic prostate adenocarcinoma. The patient underwent treatment and achieved clinical improvement. CONCLUSIONS In middle-aged men, it is important to include metastatic prostate adenocarcinoma in the differential diagnosis of cavernous sinus syndrome, even in the absence of primary tumor diagnosis.
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Affiliation(s)
- María Machío Castelló
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Diego Escobar Montatixe
- Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Cenjor Español
- Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - José Miguel Villacampa Aubá
- Department of Otolaryngology, Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Julia Montoya Bordón
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Rafael Carias Calix
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Rafael Sáez Pinel
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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19
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Kumar K, Ahmed R, Bajantri B, Singh A, Abbas H, Dejesus E, Khan RR, Niazi M, Chilimuri S. Tumors Presenting as Multiple Cranial Nerve Palsies. Case Rep Neurol 2017; 9:54-61. [PMID: 28553221 PMCID: PMC5425756 DOI: 10.1159/000456538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/11/2017] [Indexed: 12/23/2022] Open
Abstract
Cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck. The tumor can involve the cranial nerves by local compression, direct infiltration or by paraneoplastic process. Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. Multiple cranial nerve involvement could be sequential or discrete, unilateral or bilateral, painless or painful. The presentation could be acute, subacute or recurrent. Anatomic localization is the first step in the evaluation of these patients. The lesion could be in the brain stem, meninges, base of skull, extracranial or systemic disease itself. We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell lymphoma presenting as oculomotor, trochlear, trigeminal and abducens nerve palsies due to paraneoplastic involvement. History and physical examination, imaging, autoantibodies and biopsy if feasible are useful for the diagnosis. Management outcomes depend on the treatment of the underlying tumor.
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Affiliation(s)
- Kishore Kumar
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
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20
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Abu Hijla F, Yaser S, Al-Rabi K, Al-Ibraheem A, Khzouz O, Al Khairi L, Ghatasheh H, Al-Oqaily A, Khader J. Unusual presentation of non-small cell lung cancer with clival metastases: Case report. Rep Pract Oncol Radiother 2016; 21:544-7. [PMID: 27672350 DOI: 10.1016/j.rpor.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/24/2016] [Indexed: 11/26/2022] Open
Abstract
A 37-year-old female with unusual presentation of metastatic non-small cell lung cancer (NSCLC), as she presented with symptoms related to clival bone metastases. This case highlights the unpredictable presentations and the variety of metastatic sites of which metastatic NSCLC could be presented.
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Affiliation(s)
- Fawzi Abu Hijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Sameer Yaser
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Kamal Al-Rabi
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Omar Khzouz
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Laith Al Khairi
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Hamza Ghatasheh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Ayat Al-Oqaily
- Department of Pathology, King Hussein Cancer Center, Amman, Jordan
| | - Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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21
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Unusual Spread of Renal Cell Carcinoma to the Clivus with Cranial Nerve Deficit. Case Rep Neurol Med 2016; 2016:9184501. [PMID: 27110412 PMCID: PMC4811068 DOI: 10.1155/2016/9184501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/21/2016] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma (RCC) has unusual presentation affecting elderly males with a smoking history. The incidence of RCC varies while the incidence of spread of RCC to the clivus is rare. The typicality of RCC presentation includes hematuria, flank pain, and a palpable flank mass; however, RCC can also present with clival metastasis. The unique path of the abducens nerve in the clivus makes it susceptible to damage in metastasis. We report a case of a 54-year-old African American female that was evaluated for back pain, weakness, numbness, and tingling of bilateral lower extremities and subsequently disconjugate gaze and diplopia. Brain MRI confirmed metastasis to the clivus. She was started on radiotherapy and was planned for chemotherapy and transfer to a nursing home. When a patient presents with sudden unusual cranial nerve pathology, the possibility of metastatic RCC should be sought.
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22
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Shen J, Wang S, Zhao X, Shao X, Jiang X, Dai Y, Xu S, Pan X. Skull metastasis from follicular thyroid carcinoma: report of three cases and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:15285-15293. [PMID: 26823882 PMCID: PMC4713668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Jun Shen
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Sufen Wang
- Department of Pathology, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Xintong Zhao
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Xuefei Shao
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Yi Dai
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Shanshui Xu
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
| | - Xianwen Pan
- Department of Neurosurgery, Yi-Ji Shan Hospital of Wannan Medical CollegeWuhu, Anhui, China
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