title: Metastatic cerebellar tumor of papillary thyroid carcinoma mimicking cerebellar hemangioblastoma.
abstract: BACKGROUND
  Well-differentiated papillary thyroid carcinoma generally (PTC) have a favorable prognosis. This metastasis is rare in the central nervous system. Brain metastasis has a relatively poor prognosis. We present a rare case of cerebellar metastasis, one that mimics a solid type cerebellar hemangioblastoma and because of which it was very hard to reach accurate preoperative diagnosis. Accurate diagnosis was challenging because of the similar imaging and histopathological findings for these two tumors.
  
  
  METHODS
  A brain lesion was detected by routine medical checkup of the brain with MRI in a 49-year-old woman 2 years after thyroidectomy for well-differentiated PTC. Gadolinium-enhanced MRI showed a homogeneous prominently enhanced lesion with surrounding enhanced dilated vessels in the left cerebellar hemisphere. Digital subtraction angiography showed a strongly stained lesion fed by the peripheral branch of the left posterior inferior cerebellar artery with drainage into the inferior vermian vein, revealing arteriovenous shunting. The most like likely preoperative diagnosis was felt to be that of a solid cerebellar hemangioblastoma. Gross total resection of the tumor was achieved by bilateral suboccipital craniotomy, and intraoperative pathological analysis suggested hemangioblastoma. Histopathological findings showed proliferation of vacuolated sheeted tumor cells with clear and eosinophilic cytoplasm and numerous thin-walled microvessels, consistent with hemangioblastoma. However, the final diagnosis was brain metastasis of the follicular variant of PTC due to a partial thyroid follicle-like pattern including eosinophilic fluid pathologically and positive TTF-1 immunostaining.
  
  
  RESULTS
  Since presented rare case of cerebellar metastasis of PTC was very similar to solid type cerebellar hemangioblastoma on imaging and histopathological findings, accurate diagnosis was challenging. Moreover, it is extremely rare for a cerebellar metastasis to occur as an initial distant metastasis of PTC, and hemangioblastoma is the most common primary cerebellar neoplasm in adults. This epidemiological data was also one of the reason of difficulty to reach preoperative accurate diagnosis.
  
  
  CONCLUSIONS
  To the best of our knowledge, there are no other reports of challenging diagnosis case of these two tumors in the literature. Brain metastasis of a well-differentiated PTC could be a relatively poor prognostic factor, and accurate diagnosis and suitable surgical therapy or radiotherapy are needed.
authors.affiliation: Department of Neurosurgery, Ube-kohsan Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan ; Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Makoto
authors.identifier: 0000-0002-6406-9117
authors.initials: M
authors.lastname: Ideguchi
authors.affiliation: Department of Neurosurgery, Ube-kohsan Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nishizaki
authors.affiliation: Department of Neurosurgery, Ube-kohsan Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Ikeda
authors.affiliation: Department of Neurosurgery, Ube-kohsan Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Department of Neurosurgery, Ube-kohsan Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Okamura
authors.affiliation: Department of Neurosurgery, Ube-kohsan Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151 Japan.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Fujii
authors.affiliation: Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Tokuhiro
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ikeda
keywords: Cerebellar hemangioblastoma; Challenging diagnosis; Metastatic cerebellar tumor; Papillary thyroid carcinoma; Solid tumor