Skull Metastasis Extending to the Superior Sagittal Sinus: An Unfamiliar Presentation of Papillary Thyroid Carcinoma

Differentiated Thyroid Cancer Presenting With Solitary Bony Metastases to the Frontal Bone of the Skull

A 75-year-old lady was referred to the oral and maxillofacial surgery (OMFS) team with a painless swelling in the midline of her forehead. Investigations diagnosed it as a solitary metastasis of thyroid cancer. Follicular thyroid cancers are known to metastasise to bone; however, bony metastasis to the frontal bone of the skull is very rare. This case highlights how the effective use of a multidisciplinary team can lead to better patient outcomes. The patient went on to have a total thyroidectomy and received both radioactive iodine therapy and radiotherapy to the bony metastasis.

Thyroid papillary carcinoma with an insular component metastasizing to the sella turcica and sphenoid sinus: Case report

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The metastatic invasion of the skull develops in 2.5%–5.8% of the cases and mostly affects the sella turcica, pituitary gland, cavernous sinus and sphenoid sinus.

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The presence of an insular component in a well-differentiated thyroid carcinoma seems to be associated with a poor prognosis.

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Besides surgery and external beam radiation, kinase inhibitors seem to be the best option in radioiodine refractory tumor.

Introduction

Papillary carcinoma accounts for approximately 80% of all thyroid carcinomas. It is associated with relatively good survival. Distant metastases occur in approximately 10% of the patients, with the lung and bone being the most commonly reported sites.

We present a case of unusual metastasis to the sphenoid bone and sella turcica from papillary thyroid carcinoma with an insular component.

Case presentation

We present a case of 70 years old female patient who presents a voluminous goiter with an 11 cm mass of the left sixth rib. Trans-parietal biopsy proved its metastatic origin from a thyroid papillary carcinoma. The patient was treated with total thyroidectomy and radiation therapy as the metastatic tissue is radioiodine refractory. Pathology revealed a papillary carcinoma with an insular component. A year later, the patient develops another metastasis to the sphenoid bone extending to the sella turcica, cavernous sinus, and carotid arteries. Treatment was based on kinase inhibitor.

Discussion

Metastatic invasion of the skull develops in 2.5%–5.8% of differentiated thyroid carcinoma and mostly affects the sella turcica, pituitary gland, cavernous sinus and sphenoid sinus.

The presence of an insular component in a well-differentiated thyroid carcinoma seems to be associated with a poor prognosis.

For cases where the metastatic disease is found to be resistant to conventional therapies, some clinical trials show promise with the use of tyrosine kinase inhibitors such as Sorafenib.

Conclusion

Management of such uncommon cases remains challenging and should take in consideration evidence based guidelines, prognostic factors, disease progression path and treatment morbidity.

Metastatic thyroid carcinoma presented as a large craniofacial mass: Case report and CT findings

Cranial metastases are uncommon locations of thyroid papillary carcinoma. They significantly reduce patients’ survival, especially in a context of late management. We report the case of a 46-year-old woman who presented an anterior cervical swelling, then a progressive large craniofacial mass for more than 5 years without any treatment. The imaging performed showed a large craniofacial tissue mass with frontotemporal and right orbital bone destruction extended to the face sinuses and the underlying extradural space without brain involvement; the second thyroid tumor right site had similar imaging characteristics to the cranial mass. The diagnosis of papillary carcinoma with craniofacial metastasis was retained after cranial biopsy and thyroid cytology. At this stage, a cranial surgery has not been proposed but a palliative hormonal treatment. The patient died 2 weeks after diagnosis. This case illustrates the relevant role of imaging in the assessment of thyroid tumors and the value of early management for improving patients’ survival.

Clinical outcomes and prognostic factors in patients with no less than three distant organ system metastases from differentiated thyroid carcinoma

OBJECTIVES

For patients with differentiated thyroid carcinoma (DTC), distant metastases are commonly identified in the lungs and bones. However, they are relatively rare in other distant organs, such as the liver, kidneys, or brain. The aim of the current study was to describe the clinical outcomes and evaluate the prognostic factors of patients with no less than three different distant organ system metastases from DTC.

METHODS

This study retrospectively identified 717 patients diagnosed with DTC with distant metastases between January 2005 and December 2017. Patient response to radioactive iodine (RAI) therapy was monitored by changes in serum thyroglobulin levels and imaging changes. Five-year and 10-year overall survival (OS) rates were calculated by the Kaplan-Meier methods and Cox proportional hazards.

RESULTS

Among the 717 participants, 37 (5.16%) patients had no less than three different distant organ system metastases from DTC. Five-year and 10-year OS were 45.9% and 37.8% in patients with three or more distant organ system metastases while 74.5% and 64.9% in individuals with one or two distant organ system metastases, respectively. RAI avidity and RAIR-DTC were main independent prognostic factors influencing the clinical outcomes for both groups of patients. The presence of 3 or more different distant organ system metastases was the only independent prognostic factors for 10-year OS by multivariate analysis.

CONCLUSIONS

Patients with no less than three distant organ system metastases from DTC had poor prognosis. RAI avidity and RAIR-DTC were main factors influencing overall survival for patients with distant metastases from DTC in both groups.