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Huang HH, Ji P, Peng SK. Unmasking the Silent Invader: A Rare Case of Follicular Thyroid Carcinoma With Skull Metastasis and an Uncommon KRAS Q61R Mutation. Cureus 2023; 15:e47641. [PMID: 38021925 PMCID: PMC10668626 DOI: 10.7759/cureus.47641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Follicular thyroid carcinoma (FTC) is a noteworthy subtype of thyroid cancer known for its tendency to metastasize through the bloodstream, usually to the lungs and bones. This case report examines an exceptionally rare instance involving an 81-year-old female presenting with an unusual metastatic scalp lesion. Remarkably, this aggressive metastasis originated from a thyroid lesion as small as 0.7 cm. Lab findings, including suppressed TSH and elevated T3 levels, revealed subclinical hyperthyroidism, adding another layer of rarity to this FTC case. Molecular profiling identified a rare KRAS Q61R mutation, providing potential insight into the case's aggressive behavior and underscoring the importance of genetic assessment in FTC. This report emphasizes the critical role of comprehensive diagnostic evaluations, including histopathological assessments, in properly diagnosing and managing FTC, especially when clinical presentations defy conventional paradigms.
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Affiliation(s)
- Hehua Hannah Huang
- Pathology and Laboratory Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
| | - Ping Ji
- Pathology and Laboratory Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
| | - Shi-Kaung Peng
- Pathology and Laboratory Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
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2
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Chen L, Wu Y, Bai H, Liu H, Li X. A double mutation of BRAF L597Q and V600E in situ and solitary brain metastasis of occult papillary thyroid carcinoma: A case report. Medicine (Baltimore) 2021; 100:e24458. [PMID: 33578538 PMCID: PMC7886408 DOI: 10.1097/md.0000000000024458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/27/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The rare BRAF L597Q (c.T1790A) point mutation has been previously reported in childhood acute lymphoblastic leukemia. We present the first rare case of occult papillary thyroid carcinoma with BRAF L597Q mutation in a Tibetan patient. PATIENT CONCERNS A 57-year-old male patient presented with a protruding mass on the left forehead for 2 years and numbness in the right limb for 3 weeks. DIAGNOSES The patient had a double mutation of BRAF L597Q and V600E in 2 separate lesions at thyroid and brain, the immunohistochemical staining showed that the cytokeratin (CK), thyroglobulin (Tg) and thyroid transforming factor-1 (TTF-1) were immunoreactive. All the findings supported the diagnosis of solitary brain metastasis of occult papillary thyroid carcinoma. INTERVENTIONS The patient underwent left frontal lobe metastasis (thyroid cancer) resection that involved craniectomy and artificial skull repair. OUTCOMES During the 24-month follow-up, no postoperative complications or recurrence and metastasis were found. LESSONS This is the first case of solitary brain metastasis of occult papillary thyroid carcinoma with double mutation of BRAF L597Q and V600E in 2 separate lesions reported in the literature. Our study extends the disease spectrum of occult papillary thyroid carcinoma and suggests that the BRAF L597Q mutation might play a specific role in inducing the solitary brain metastasis of occult papillary thyroid carcinoma in a Chinese Tibetan patient, but the detailed molecular mechanism remains to be confirmed by a large number of functional experiments and clinical research.
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Affiliation(s)
- Ling Chen
- Doctor of Medicine, Key Laboratory of Molecular Biology of Infectious Diseases, Ministry of Education, Chongqing Medical University
| | - Yue Wu
- Bachelor of Medicine, Oncology Department
| | - Huili Bai
- Master of Medicine, Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Huandong Liu
- Bachelor of Medicine, Department of Neurosurgery, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Xiaosong Li
- Master of Medicine, Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing
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3
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Phelan PS, Mull JL, Rajput MZ, Musiek AC. Concurrent metastases of papillary thyroid carcinoma to the scalp and Meckel's cave. BMJ Case Rep 2018; 2018:bcr-2017-222552. [PMID: 29914897 DOI: 10.1136/bcr-2017-222552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 65-year-old man with severe headaches and unilateral facial weakness, seen in consultation by the dermatology service to rule out primary cutaneous melanoma after brain imaging identified an enlarging mass within the right trigeminal (Meckel's) cave. Examination revealed only a pair of erythematous papules on the scalp, for which biopsy demonstrated metastatic papillary thyroid carcinoma. Further evaluation and subsequent thyroidectomy confirmed the origin of widespread internal disease, followed by definitive excision of scalp lesions and multimodal management of systemic involvement. Whereas presentation of metastasis to the skin is highly variable, a low threshold for biopsy may allow for histological identification of internal disease not otherwise considered in the clinical differential.
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Affiliation(s)
- Patrick S Phelan
- Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jamie L Mull
- Division of Dermatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Mohamed Z Rajput
- Washington University in Saint Louis School of Medicine, Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
| | - Amy C Musiek
- Division of Dermatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
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Abstract
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, University of Virginia, Charlottesville, VA, United States.
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5
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Acute cavernous sinus syndrome due to metastatic infiltration of the cavernous sinus and clivus: Unknown primary. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tunio MA, Al Asiri M, Al-Qahtani KH, Aldandan S, Riaz K, Bayoumi Y. Skull base metastasis from papillary thyroid carcinoma: a report of three cases. Int Med Case Rep J 2015. [PMID: 26203287 PMCID: PMC4487156 DOI: 10.2147/imcrj.s82792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Skull base metastasis from differentiated thyroid carcinoma, including papillary and follicular thyroid carcinoma, is a rare manifestation. Herein, we present three cases of skull base metastasis of papillary thyroid carcinoma. The mean age of the patients was 68.6 (65–74) years, and the mean interval between initial diagnosis and skull base metastasis was 56.3 (28–89) months. Cranial nerve palsies were seen in all patients. Intensity modulated radiation therapy to deliver 6,000–6,600 cGy to the skull base metastasis was given to all patients, in addition to partial resection in one patient. At the time of last follow-up, all skull base metastases were well controlled.
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Affiliation(s)
- Mutahir A Tunio
- Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mushabbab Al Asiri
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Hussain Al-Qahtani
- Department of Otolaryngology -Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sadiq Aldandan
- Department of Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Riaz
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Bayoumi
- Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Li X, Zhao G, Zhang Y, Ding K, Cao H, Yang D, Zhang J, Duan Z, Xin S. Skull metastasis revealing a papillary thyroid carcinoma. Chin J Cancer Res 2013; 25:603-7. [PMID: 24255586 DOI: 10.3978/j.issn.1000-9604.2013.09.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/23/2013] [Indexed: 01/26/2023] Open
Abstract
Although thyroid carcinoma is a relatively common form of malignancy, metastatic spread to the skull is rare. Here, we report a case of papillary thyroid carcinoma with frontal and parietal metastasis. A 61-year-old Chinese woman presented with a one year history of a growing mass on the center of the frontal and parietal bone, initially thought to be meningioma. Biopsy of the skull base mass after intracalvarium excision, indicated a tumor of thyroid origin. One month later the patient underwent a total thyroidectomy. Pathological examination confirmed a diagnosis of papillary thyroid carcinoma with frontal and parietal bone metastasis. Based on this experience, the key to successful management of the skull metastasis of thyroid carcinoma is prompt diagnosis and appropriate treatment. Skull metastasis should be considered at the outset of the clinical course of papillary thyroid cancer. To facilitate this, patients should be meticulously investigated by a multidisciplinary team to improve quality of life.
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Affiliation(s)
- Xi Li
- Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
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Matsuno A, Murakami M, Hoya K, M. Yamada S, Miyamoto S, Yamada S, Son JH, Nishido H, Ide F, Nagashima H, Sugaya M, Hirohata T, Mizutani A, Okinaga H, Ishii Y, Tahara S, Teramoto A, Osamura RY, Yamazaki K, Ishida Y. Clinicopathological and molecular histochemical review of skull base metastasis from differentiated thyroid carcinoma. Acta Histochem Cytochem 2013; 46:129-36. [PMID: 24194626 PMCID: PMC3813819 DOI: 10.1267/ahc.13019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/03/2013] [Indexed: 02/02/2023] Open
Abstract
Skull base metastasis from differentiated thyroid carcinoma including follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) is a rare clinical entity. Eighteen FTC cases and 10 PTC cases showing skull base metastasis have been reported. The most common symptom of skull base metastasis from FTC and PTC is cranial nerve dysfunction. Bone destruction and local invasion to the surrounding soft tissues are common on radiological imaging. Skull base metastases can be the initial clinical presentation of FTC and PTC in the presence of silent primary sites. The possibility of skull base metastasis from FTC and PTC should be considered in patients with the clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction. A variety of genetic alterations in thyroid tumors have been identified to have a fundamental role in their tumorigenesis. Molecular histochemical studies are useful for elucidating the histopathological features of thyroid carcinoma. Recent molecular findings may provide novel molecular-based treatment strategies for thyroid carcinoma.
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Affiliation(s)
- Akira Matsuno
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Mineko Murakami
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Katsumi Hoya
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Shoko M. Yamada
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Shinya Miyamoto
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - So Yamada
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Jae-Hyun Son
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Hajime Nishido
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | - Fuyuaki Ide
- Department of Neurosurgery, Teikyo University Chiba Medical Center
| | | | - Mutsumi Sugaya
- Department of Rehabilitation, Teikyo University Chiba Medical Center
| | - Toshio Hirohata
- Department of Neurosurgery, Teikyo University Chiba Medical Center
- Department of Neurosurgery, The University of Tokyo
| | - Akiko Mizutani
- Department of Neurosurgery, Teikyo University Chiba Medical Center
- Teikyo Heisei University
| | | | - Yudo Ishii
- Department of Neurosurgery, Nippon Medical School
| | | | | | - R. Yoshiyuki Osamura
- Department of Pathology, International University of Health and Welfare Mita Hospital
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center
| | - Yasuo Ishida
- Department of Pathology, Teikyo University Chiba Medical Center
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Chamoun RB, Suki D, DeMonte F. Surgical management of cranial base metastases. Neurosurgery 2012; 70:802-9; discussion 809-10. [PMID: 21937928 DOI: 10.1227/neu.0b013e318236a700] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cranial base metastases (CBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors. OBJECTIVE To report surgical outcomes in a consecutive series of patients with CBM and to better define the role of surgery in their management. METHODS Twenty-seven patients with CBM underwent surgery between 1996 and 2009 at MD Anderson Cancer Center. A retrospective review of their prospectively collected data was performed after obtaining institutional review board approval. The median patient age was 52 years. The most common pathology was renal cell carcinoma (6 patients). Surgical indications were worsening neurological deficit, disfiguring mass, and the need for a diagnosis. RESULTS Gross total resection was achieved in 59% of the cases. The median survival was 11.4 months. The median progression-free survival was 5.8 months. A Karnofsky Performance Scale score less than 90, dural invasion, and brain invasion were associated with a shorter survival. Seven patients were neurologically intact preoperatively; all of them remained intact after surgery. Among all patients with preoperative neurological deficit, 11 remained stable, 7 improved, and 2 had worsening of their deficit postoperatively. CONCLUSION The goal of surgery for CBM is to provide symptom relief and to preserve functional status in well-selected cases. Patient selection is critical because the surgery is usually palliative, and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.
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Affiliation(s)
- Roukoz B Chamoun
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA
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10
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Matsuno A, Katakami H, Okazaki R, Yamada S, Sasaki M, Nakaguchi H, Yamada SM, Hoya K, Murakami M, Yamazaki K, Ishida Y, Iwasaki H, Kuyama J, Kakudo K. Skull base metastasis from follicular thyroid carcinoma -two case reports-. Neurol Med Chir (Tokyo) 2010; 50:421-5. [PMID: 20505304 DOI: 10.2176/nmc.50.421] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 58-year-old woman and a 71-year-old woman presented with extremely rare skull base metastases from follicular thyroid carcinoma (FTC). Surgical removal and external radiotherapy were performed followed by iodine-131 ((131)I) brachytherapy and thyroid hormone administration. The metastatic tumors in the skull base were well controlled. Treatment for skull base metastasis from FTC includes surgical debulking of the metastatic lesion, as well as complete resection of the thyroid gland, followed by internal irradiation with (131)I, external irradiation, and administration of thyroid hormone to prevent tumor growth by suppression of endogenous thyroid-stimulating hormone. Skull base metastases may be the initial clinical presentation of FTC, with silent primary sites. The possibility of skull base metastasis from FTC should be considered in patients with clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction.
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Affiliation(s)
- Akira Matsuno
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
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11
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Feng D, Rhatigan R, Shuja S, Wolfson D, Makary R, Koch K, Masood S. Papillary thyroid carcinoma with metastasis to the frontal skull. Diagn Cytopathol 2009; 37:522-6. [DOI: 10.1002/dc.21070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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