Introduction: Thyroid carcinoma accounts for 1% of all thyroid tumours. Bone metastasis occurs in 10 to 40%, with skullmetastasis accounting for 2.5 to 5.8% of bone metastases. The largest series of skull metastasis from thyroid carcinoma described a frequency of only 2.5% among 473 patients. The majority of skull metastasis from thyroid cancers is of the follicular subtype. She can occur at any age, the youngest patient was just 18 years old but most patients are between 60 and 70 years old. We report an unusual case of an adolescent girl of an 16-year-old with a metastatic thyroid follicular carcinoma of the skull.
Case report: 16-year-old M.A presents with a swelling in the parietal region of the skull. She incidentally noted the swelling which then gradually increased in size. Patient consults for cephalgias, sensation of intracranial hypertention and right parietal hump appeared six months rather. The spinal IRM concludes a solidokystic osteolytic process of the right parietal worm with endocranial development and a local pachy meningeal reaction. Thoracoabdominopelvic CT without abnormalities. The patient underwent total exeresis of the tumor with cranioplasty. Histological examination revealed the diagnosis of a bone metastasis of vesicular carcinoma of the thyroid.with positive staining for thyroid transcription factor -1 (TTF-1) and thyroglobulin (TG). The thyroid echography found two suspicious nodules TIRADS5. The patient was operated on and underwent a total thyroidectomy with recural lymph node dissection and bilateral jugulocarotidien. The histological study of the piece is in favor of a bilateral papillary microcarcinoma of 4 mm at left and of 3 mm on the right classified PT1m N0 M1.Totalized isotopically by 100 mCi I131 and suppressive treatment with thyroxine.
Discussion Conclusion: Anatomically, skull metastatic lesions are most frequently located over the occipital region, Its wase noticed that this lesion is osteolytic on CT scan. Histological examination commonly reveals follicular carcinoma, usually well-to-moderately differentiated, but occasionally a mixed follicular-papillary pattern has been noted. The treatment of children and adolescents with differentiated thyroid carcinoma is more controversial than the treatment of adults. Primarily because of the rarity of skull metastasis with thyroid carcinoma, the role of standard postoperative therapy for this situation has not been definitively established.
18 - 21 May 2019
European Society of Endocrinology