Management Considerations for Differentiated Thyroid Carcinoma Presenting as a Metastasis to the Skull Base

Abstract

Distant metastasis from differentiated thyroid carcinoma needs to be considered in the differential diagnosis of destructive skull base lesions, regardless of the patient's age. Histopathologic tissue diagnosis should always be attempted, followed by total thyroidectomy, radioiodine, or external beam radiation, and chronic thyroid-stimulating hormone suppression. Surgical resection of the metastatic lesion should only be performed in carefully selected cases because it is associated with significant morbidity.

Skull Base Metastasis From Follicular Thyroid Carcinoma -Two Case Reports-

“…4,5,12,13,17,25,26,28,29,[32][33][34][35][36][37]41,42,45) Mean age was 55.6 years, ranging from 23 to 74 years. Bone metastasis from thyroid carcinoma is often observed in the sixth and seventh decades of life.…”

“…The lung is the most common metastatic site for thyroid carcinoma followed by the bone, 7,10,26,27) but skull metastasis of thyroid carcinoma is rare, with few reported cases. [1][2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]25,26,[28][29][30][31][32][33][34][35][36][37][38]40,41,44,45) The largest series of skull metastasis from thyroid carcinoma reported a frequency of only 2.5% among 473 patients. 26) Moreover, skull base metastasis from differentiated thyroid carcinoma is even rarer, with only 23 reported cases, including 17 cases of skull base metastasis from FTC that involved the clivus, cavernous sinus, sella turcica, petrous apex, and petrous ridge.…”

“…26) Moreover, skull base metastasis from differentiated thyroid carcinoma is even rarer, with only 23 reported cases, including 17 cases of skull base metastasis from FTC that involved the clivus, cavernous sinus, sella turcica, petrous apex, and petrous ridge. 4,5,12,13,17,25,26,28,29,[32][33][34][35][36][37]41,42,45) We treated two patients with skull base metastasis from FTC, and discuss the treatment modalities.…”

Metachronous solitary metastasis of papillary thyroid cancer in the cavernous sinus: Case report and review of literature

“…[3] There have been case reports of papillary carcinoma with metastasis at unusual sites like the pancreas, breast and cavernous sinus. [4,5] But all these cases were associated with a missed diagnosis of thyroid carcinoma, locally recurrent tumor, multiple distant metastases, or metastases presenting synchronously with the primary. Our case, presenting three and a half years after total thyroidectomy, with a solitary metastasis in the para-sellar region and the cavernous sinus, without any other distant metastasis or local recurrence, should be considered exceptional.…”

Discharging ear and facial palsy: Clinical presentation of metastatic follicular carcinoma of thyroid in temporal bone- a case report

“…Detection of metastases after treatment of primary thyroid cancer frequently poses difficulty in diagnosis. There is no uniform consensus on the management strategy for skull metastasis as the cases were not common and reported by different authors as case reports with their own experience and opinion 11 . Treatment strategy is individualized according to the extension of disease.…”