Isolated parietal-skull metastasis from a thyroid papillary carcinoma
Cristina Preda, Roxana Novac, Delia Ciobanu, Alexandru Grigorovici, Letitia Leustean, Maria-Christina Ungureanu, Cristina Cristea & Eusebie Zbranca
Papillary carcinoma is the most common differentiated malignant thyroid neoplasm. Metastasis commonly occur in regional lymph nodes and distant metastasis ia a late and rare occurrence.
Papillary thyroid carcinoma with metastasis to the parietal skull is very rare.
We present the case of a parital skull metastasis arising from a papillary carcinoma prior to the diagnosis of thyroid tumor. The patient was a 58 caucasian woman with presentation of a 3.5 cm painless, immobile, firm mass on the left side of the head (parietal area). The X-ray and computer tomography detected an osteolitic tumor involving the skull and overlying skin. The tumor was removed and the histological examination revealed the presence of clusters of oval cells with squamoid cytoplasm and oval nuclei. At that moment it was the question regarding the differential diagnosis between colon carcinoma or thyroid carcinoma metastasis. With immunocytochemical stain the neoplastic cells were positive for thyroglobuline. The ultrasound of the thyroid showed multiple hypoechoic solid nodules with microcalcifications in both lobes. Ultrasound- guided fine-needle biopsy was performed and cytological exam. was conclusive for papillary carcinoma. The patient underwent total thyroidectomy with central and lateral node dissection. Final pathological exam. conclude for papillary carcinoma (follicular variant).
Even if skull metastasis of thyroid carcinoma is rare, it should be considered in the differential diagnosis when a skull mass lesion is encountered.