title: Management considerations for differentiated thyroid carcinoma presenting as a metastasis to the skull base.
abstract: OBJECTIVE
  To characterize the salient features of skull base metastasis from differentiated thyroid carcinoma, discuss the diagnostic and treatment strategies, and propose rational management guidelines for such tumors.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Review of English literature from MEDLINE with the addition of our case.
  
  
  RESULTS
  Skull base metastasis from differentiated thyroid carcinoma is rare, with only 20 cases reported to date, including our case report. On the basis of a review of all reported cases, both follicular and papillary thyroid cancers can metastasize to the skull base. Our case is unique because the lesion extends locally into the cavernous sinus and beyond. Histopathologic diagnosis is limited by the remote location of lesions. Most tumors are highly vascular, and there is potential for significant morbidity and mortality associated with surgical resection. The overall survival ranges from less than one year to 10+ years from the discovery of the metastasis and is similar in both tumor subtypes. There is no clear consensus on the management strategy for skull base metastasis from differentiated thyroid carcinoma. Interestingly, surgical resection of both the primary and metastatic lesions yields similar survival when compared with resection of the primary tumor alone.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Wojciech K
authors.initials: WK
authors.lastname: Mydlarz
authors.forename: Julie
authors.initials: J
authors.lastname: Wu
authors.forename: Nafi
authors.initials: N
authors.lastname: Aygun
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.forename: John P
authors.initials: JP
authors.lastname: Carey
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D000368:Aged; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy
chemical_list: D013954:Thyroglobulin