Extremely Well-Differentiated Papillary Thyroid Carcinoma Resembling Adenomatous Hyperplasia Can Metastasize to the Skull: A Case Report

We describe herein histologic, immunohistochemical, and molecular findings and clinical manifestations of a rare case of an extremely well differentiated papillary thyroid carcinoma (EWD-PTC). Similarly, it is also difficult to diagnose follicular variant papillary thyroid carcinoma (FVPTC), whose diagnosis is still met with controversy. A recently reported entity of well-differentiated tumor of uncertain malignant potential (WDT-UMP) is added to the diagnostic spectrum harboring EWD-PTC and FVPTC. We report this case, because EWD-PTC is different from FVPTC in its papillary architecture, and also from WDT-UMP in its recurrence and metastatic pattern. These morphologically deceptive entities harbored diagnostic difficulties in the past because the diagnosis depended solely on histology. However, they are now diagnosed with more certainty by virtue of immunohistochemical and molecular studies. We experienced a case of EWD-PTC, which had been diagnosed as adenomatous hyperplasia 20 years ago and manifested recurrence with lymph node (LN) metastasis 7 years later. After another 7 years of follow-up, a new thyroid lesion had developed, diagnosed as FVPTC, with LN metastasis of EWD-PTC. One year later, the patient developed metastatic FVPTC in the skull. Immunohistochemically, the EWD-PTC was focally positive for CK19, negative for galectin-3, and focally negative for CD56. Molecular studies revealed BRAF-positivity and K-RAS negativity. The FVPTC in the left thyroid showed both BRAF and K-RAS negativity. In conclusion, EWD-PTC and FVPTC share similar histologic features, but they are different tumors with different molecular biologic and clinical manifestations. A large cohort of EWD-PTC should be included in further study.

Follicular thyroid carcinoma presenting initially with skull metastasis

Follicular thyroid carcinoma very rarely present initially with metastasis to skull. This report describes an otherwise asymptomatic 52 years old female patient with follicular thyroid carcinoma, who initially presented with soft mass in right occipito-parietal region and a multinodular goiter. Radiology showed an osteolytic lesion with overlying soft tissue component. Histopathology revealed metastasis from a well differentiated follicular carcinoma of thyroid gland

Undifferentiated carcinoma of the submandibular salivary gland with fulminant clinical course: a case report.

Undifferentiated carcinoma of salivary glands is too poorly differentiated to be classified as any of the specific group of carcinomas. This is a rare disease, the incidence of which is rather low-to-very low in the Indian subcontinent. The tumor can assume an aggressive clinical behavior characterized by disseminated metastases. The prognosis is rated as dismal; as evidenced by this clinical report of a tumor in the submandibular salivary gland with synchronous metastases to the skull bones and in to the intracranial fossa. The putative relationship of the tumor to Epstein-Barr virus (EBV) infection is discussed.

Thyroid cancer with skull enlargement: a lesson learned?

A case of endemic goitre associated with thyroid cancer and huge enlargement of the scalp is reported in a Brazilian mulatto from an iodine deficient Central west region of the country. On admission, osteolytic metastases of follicular thyroid carcinoma were found scattered in the parietal bones. Impressive images from old files could illustrate and emphasize the hurdle-like role of poverty and inadequate social and cultural attitudes before the fight against cancer in regions with limited resources. Even in developed countries, goitres still occur in areas with iodine prophylaxis. Another concern is insufficiency of reliable data on the incidence and pattern of head and neck tumours in developing countries.

Skull metastasis as the first presentation of hepatocellular carcinoma

Skull metastasis from Hepatocellular carcinoma, specially as the first presentation is very rare. We report a case with a history of head trauma in Bam earthquake and craniotomy due to lytic tumor of the skull, presented with upper gastrointestinal symptoms which Hepatocellular carcinoma with skull metastasis was revealed .the patient was infected with hepatitis B virus without cirrhosis

Follicular carcinoma of thyroid with synchronous bony and soft tissue metastases.

A 65 years old lady presented with a large thyroid swelling along with a soft, non-tender mass over the left parietal region and a small, hard, non-tender swelling over the volar aspect of right forearm. FNAC reports from the thyroid gland and the swellings over head and forearm all revealed features of follicular neoplasm. Excision biopsy of the forearm swelling showed histology of metastatic poorly differentiated follicular adenocarcinoma of thyroid. The patient underwent total thyroidectomy followed by excision of the mass over the head, a week later. She was discharged in favourable condition with advice to attend oncology department for subsequent management. She is yet to attend surgical outdoor for follow-up.

Aggressive recurrent odontogenic ghost tumor with cranial invasion

Calcifying odontogenic cyst [COC] is a unique odontogenic lesion with combined features of a cyst and neoplasm. This lesion shows a great diversity in its clinicopathological behavior. It may become aggressive and rarely malignant. This case is an aggressive COC of the maxilla in a young male patient which recurred after several radical surgical excisions. Eventually invading the cranium, the lesion neither responded to surgical excision nor to radiotherapy

rare case of malignant ameloblastoma with Multicentric presentation

Malignant ameloblastoma accounts for less than 1% tumour of the faciomaxillary region, arising from epithelial odontogenic cells or dental lamina. The commonest site is the ascending ramus of mandible and maxilla. A rare case of malignant ameloblastoma at unusual sites is reported. It is important to identify this condition to offer adequate excision and prevent recurrence. This is a case of 9 years old male child, who presented a mass in left cheek and inguinal mass with amputated right leg. Complete excision of the maxilla and inguinal mass was carried out and confirmed as a metastatic malignant ameloblastoma both in maxilla and inguinal region. There was recurrence of the same growth in the right maxilla and skull bones after one year. This is a unique presentation of ameloblastoma spreading to remote areas in the body that has not been reported in the literature. A 9 years old male child was admitted in our ENT Department at Lady Reading Hospital, Peshawar on May-June 1998 with history of swelling left cheek and right inguinal mass. The cheek swelling appeared 10 months back and rapidly increased in size in the last 3 months. It was progressively pushing the left eye ball upward and medially with a proptosis and intact vision. There was history of nasal obstruction with blood stained nasal discharge. He had epiphora as well. On physical examination patient revealed 8x9 cm irregular solid mass of the left cheek which totally occupied the left nasal cavity with protrusion of the lateral wall, left palate and alveolus resulting in loosening of teeth. The mass was smooth and non-tender. The local temperature over the mass was normal, the overlying skin was intact and freely mobile over the mass. On systemic examination there was a mass 8x9 cm in the right inguinal region. The overlying tissue was normal, in the past patient suffered from the same lesion of the right lower limb which was amputated on October 10,1992. Mass from the right axilia was excised by the general surgeon and reported as adamantinoma on histopathology in November 13, 1996. The lesion of the left maxilla and right groin appeared during the last ten months

Metastatic tumors in the sellar and parasellar regions: clinical review of four cases

Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.

La resonancia magnética en las lesiones deformantes de la calota craneana / MR evaluation of deforming skull lesions

Presentamos cuatro casos inhabituales de lesiones neoplásicas deformantes de la cabeza (dos varones de 23 y 56 años y dos mujeres de 24 y 84 años) estudiados con RM contrastada. Se analizaron las imágenes de Resonancia Magnética comparándolas con las obtenidas con tomografías computadas y con los resultados de casos similares comunicados en la literatura. Proponemos la utilización de la RM contrastada y con técnica de supresión de la grasa ante lesiones deformantes de la calota craneana de probable origen neoplásico, como complemento del estudio del hueso cortical mediante Rx y/o TC, en la estadificación previa al tratamiento

Compromiso nervio craneal en cáncer de próstata metastico / Craneal nerves compromised with metastasic prostate cancer

Es usual en el Cáncer de Próstata avanzado la metástasis ósea, pero no su localización en los huesos de la base del cráneo con compromiso de pares craneales. El propósito de este trabajo es presentar un caso clínico con afectación única del VI par craneal por invasión ósea metastásica con buena respuesta sintomático al tratamiento. Se trata de un paciente de 62 años con alteraciones del nervio motor ocular externo, debido a metástasis óseas de un cáncer de Próstata avanzado, diagnosticado 2 años antes. La sintomatología consistió en mareos, diplopia y cefalea. La TAC de Cráneo y el Centellograma Oseo demostraron metástasis en toda la calota y base del cráneo. Como tratamiento recibió radioterapia externa ( RTE) 4.000 cgy en los huesos de la base del cráneo. Se obtuvo la resolución completa del déficit neurológico, con el alivio de los síntomas concomitantes. Sin embargo a los 5 meses la enfermedad continuó su evolución hasta fallecer 2 meses después. La conclusión es que la aparición de la afectación neurológica descripta ensombrece el pronóstico, aunque el tratamiento radiante mejore transitoriamente los síntomas y la calidad de vida

Tumor metastático no glomus jugular / Metastatic tumors in glomus jugular

Os autores descrevem um caso incomum de metástase de adenocarcinoma renal, localizado na regiäo petrosa e occiptal da base do crânio, onde o diagnóstico diferencial com tumor do glomus da jugular só foi posível após estudo histológico. Tumores metastáticos chegam comumente ao osso temporal por via hematogênica. Salientam também a dificuldade do diagnóstico pré-operatório. Em geral, o diagnóstico da metástase do osso temporal é baseado na suspeita clínica, confirmada pelos exames por imagem.

Raras metástasis y evolución en un paciente con neoplasia vesical / Rare metastases and course in a patient with vesical neoplasm

Se presenta un caso clínico de frecuencia poco común. Se trata de un paciente que presenta neoplasia vesical de alto grado de diferenciación, operado y en el que posteriormente se descubren metástasis a nivel de la médula espinal y el cráneo. El paciente evoluciona muy favorablemente sin tratamiento citostático o radioterápico, no presenta recidiva tumoral y se observa disminución de las células metastásicas de la médula espinal. Los resultados son evaluados a los 9 años y 6 meses de operado. Realizamos un breve recordatorio anatomopatológico de la neoplasia vesical