Unusual brain metastases from papillary thyroid carcinoma: case report.
OBJECTIVE
Brain metastases from papillary carcinoma of the thyroid gland are unusual. No consensus regarding management has yet been reached. We report a case, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data.


METHODS
A 33-year-old woman presented with signs of intracranial hypertension. The diagnostic evaluation included chest tomography, head computed tomography, brain magnetic resonance imaging with and without contrast enhancement, total-body scanning, and cerebral scintigraphy. Multiple supratentorial lesions and one right cerebellopontine angle lesion were observed. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland.


METHODS
A ventriculoperitoneal shunt was placed and a right suboccipital craniotomy was performed, with complete removal of the cerebellopontine angle tumor. Total-brain irradiation with 40 Gy/lesion followed the initial operation. One year after surgery, the patient presented with signs of increased intracranial pressure. A new left frontal lobe lesion with massive peritumoral edema was identified on magnetic resonance imaging scans. The edema was treated clinically and a left frontal craniotomy was performed, with complete resection of the tumor. The patient is currently faring well, with residual expressive aphasia.


CONCLUSIONS
Surgery followed by radiotherapy seems to be a good alternative for the treatment of this specific type of metastasis. Thorough clinical and radiological evaluation, followed by genetic analysis of the surgical specimen, particularly with respect to the potential for tumor invasion under specific conditions, is recommended. The information obtained contributes to better management and better overall long-term outcomes for these patients.
Aguiar
P H
PH
Pinheiros Neurosurgical Clinic, São Paulo, Brazil.
Agner
C
C
Tavares
F R
FR
Yamaguchi
N
N
D000328:Adult; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003399:Craniotomy; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt