title: Thyroid follicular carcinoma presenting as metastatic skin nodules.
abstract: BACKGROUND
  Follicular thyroid cancer (FTC) metastasizes most commonly to the lungs and non-cranial bones. Skull and skin are uncommon sites and usually manifest well after the diagnosis of primary malignancy. Metastasis to skull and skin as the presenting feature of FTC is infrequently reported in the literature.
  
  
  METHODS
  A 65-year-old Caucasian woman with a history of thyroid nodule presented with the complaint of rapidly growing skull nodules which had been present for 3 years but were stable previously. She denied any fevers, chills, history of trauma, or weight loss. She denied any history of smoking or head and neck irradiation. On physical examination, she had two non-tender gray cystic lesions - one on her left temporal region and the other on the right parietal region. Biopsy was consistent with metastatic FTC. Magnetic resonance imaging of the brain demonstrated 7.1×3.8 cm and 3.7×4.5 cm fairly homogeneous, enhancing, relatively well-defined masses centered in the posterior and left anterior lateral calvarium with intracranial and extracranial extensions but without any vasogenic edema or mass effect on the brain. Thyroid ultrasound showed numerous nodules in both lobes. The patient underwent a total thyroidectomy. Histopathological studies of the thyroid gland revealed a well-differentiated FTC in the left lobe. Then she underwent resection of the tumor in multiple stages. She did not have any recurrence of the FTC or metastases during the follow-up period and will be receiving radioactive iodine treatment.
  
  
  CONCLUSIONS
  Bone and lung are the common sites of metastasis from FTC, but involvement of skull or skin is unusual, particularly as the presenting feature. Metastases from FTC should be in the differential of patients with new osteolytic hypervascular skull lesions or cutaneous lesions in head and neck area.
authors: Department of Internal Medicine, Reading Health System, West Reading, PA, USA; asadjehangir@gmail.com.
authors: Asad
authors: A
authors: Jehangir
authors: Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
authors: Ranjan
authors: R
authors: Pathak
authors: Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
authors: Madan
authors: M
authors: Aryal
authors: King Edward Medical University, Lahore, Pakistan.
authors: Anam
authors: A
authors: Qureshi
authors: Rawalpindi Medical College, Rawalpindi, Pakistan.
authors: Qasim
authors: Q
authors: Jehangir
authors: Department of Internal Medicine, Reading Health System, West Reading, PA, USA.|Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors: Richard
authors: R
authors: Alweis
authors: Neurosurgery, Reading Health System, West Reading, PA, USA.
authors: Raymond
authors: R
authors: Truex
authors: Anatomic Pathology, Reading Health System, West Reading, PA, USA.
authors: William
authors: W
authors: Kimmel
keywords: adenocarcinoma; follicular; neoplasm metastasis; radioactive iodine; skull nodules; thyroid nodule; thyroidectomy
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