History :- Patient was 61 yrs female. Came with chief complaints of -:

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Presentation transcript:

History :- Patient was 61 yrs female. Came with chief complaints of -: Severe Headache Decreased bilateral vision A NECT Head was done Axial CT sections reveal a hyperdense mass lesion at skull base. This mass lesion was causing erosion of adjacent bones. There were evidence of specs of calcifiaction with in the mass. CECT Head was done further which revealed it to be intensely enhancing suggesting its hypervasular nature.

AXIAL CT Sections of NECT Head reveal a hypredense mass lesion at skull base with erosion of adjacent bony calvaria

CECT Head axial sections revealed it to be intensely enhancing

MRI Brain plain with contrast was done The lesion was mildly hyperintense on T1 weighted images on T2 weighted images it was isointense and showed mild restriction on diffusion weighted images. On T1 post contrast images it showed intense enhancement. There was no compression of cavernous ICA by this lesion. This lesion was extending upto formaen ovale and foramen spinosum bilaterally.

T2WI T1WI T1C+ DWI

Differentials -: Chordoma Chondrosarcoma Metastasis Exiscional Biopsy was done - Histopathological features suggested Metastatic Epthellial Mailgnancy ( possibly from Thyroid ) A USG Thyroid was done which revealed a hyoechoic nodule in right lobe of thyroid which showed internal vascularity on color doppler.

USG Thyroid -

USG guided FNAC was done - Cytomorphological features were suggestive for Follicular Neoplasm. Further body imaging was done CT Thorax revealed multiple nodules randomly distributed in bilateral lung field suggestive of canon ball metastases.

Most primary thyroid cancer are derived from follicular or parafollicular cells1. Follicular carcinoma affect women more than men1. Invasive follicular carcinoma metastasizes in 20 – 40 % cases2. Distant metastases are seen in a minority of patients and the reported rates of occurrence range from 4 to 15%3,4,5, . The most common site of distant metastases is the lung, followed by the bone6. Metastasis to skull base are rare phenomenon in thyroid malignancies. Skull metastasis is uncommon, and is found in 2.5%–5.8% of cases of thyroid cancer7. The method of spread of Thyroid Carcinoma into the skull and skull base is likely via the hematogenous route. Batson demonstrated a vertebral venous plexus which consisted of a valveless vascular bed within the spinal canal and extended from the skull to the pelvis.8 Batson and Eckenhoff showed that there were multiple anastomoses and free connections between this venous plexus and the dural sinuses, the emissary veins of the skull as well as numerous junctions with the cervical plexus.9 Recently arterial spread has also been suggested because of the association with secondary cutaneous locations in the territory of ipsilateral external carotid artery.10

Refrences - Grebe SK, Hay ID. Follicular cell derived thyroid carcinomas. Cancer Treat Res 1997;89:90-140 Hay ID, McConahey WM. Managing patient papillary thyroid carcinoma. Trans Am Clinic Climatol Asso 2002;113:241-260 Hoie J,Stenwig AE,KullmannG & Lindegaard M1988 Distant metastases in papillary thyroid cancer. A review of 91 patients.Cancer 611–6. Casara D,Rubello D,Saladini G,Masarotto G,Favero A,Girelli ME & Busnardo B 1993 Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. Journal of Nuclear Medicine 34 1626–1631. Clark JR,Lai P,Hall F,Borglund A,Eski S & Freeman JL 2005 Variable predicting distant metastases in thyroid cancer. Laryngoscope 115 661–667. Mazzaferri EL & Massoll N 2002 Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.Endocrine- Related Cancer 9 227–247. YAN Bo et al. Papillary thyroid micro carcinoma presenting as skull base metastasis.Chin Med J. 2010;123(19):2750–2752. Baston OV. The function of the vertebral vein and their role in the spread of metastasis.Ann Surg. 1940;112:138–149 Florence-Laigle D, et al. Skull-base metastases. J Neuro Oncol. 2005;75:63–66. Ortiz LP, et al. Thyroid follicular carcinoma presenting as skull and dural metastasis mimicking a meningioma: a case report. J Neurooncol. 2009;95:281–284.