Brain Tumor Res Treat.  2014 Oct;2(2):132-137. 10.14791/btrt.2014.2.2.132.

Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome

• Cho SH
• Kim SH
• Lee JH
• Joo WI
• Chough CK
• Park HK
• Lee KJ
• Rha HK

• KMID: 2134286
• DOI: http://doi.org/10.14791/btrt.2014.2.2.132

Abstract

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before. A 53-year-old female patient had been managed in ophthalmologic clinic due to vague symptoms of right monocular blurred vision with eye dryness for 3 months, but showed no signs of improvement. So it was performed a magnetic resonance imaging and magnetic resonance angiography to evaluate the possibilities of cerebral lesion. And a left frontal mass was incidentally found, and the tumor turned out to be a PTC that had metastasized to brain, regional lymph node, cervical, thoracic spine, and lung. We describe a PTC with extraordinary initial symptoms that metastasized to an unusual site. We recommend that if a papillary thyroid tumor with unusual symptoms or at an advanced stage is found, further investigation should be performed for distant metastasis.

Keyword

Papillary thyroid carcinoma; Metastases; Horner syndrome; Treatment

MeSH Terms

Brain*
Central Nervous System
Female
Horner Syndrome*
Humans
Lung
Lymph Nodes
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Middle Aged
Neoplasm Metastasis*
Physical Examination
Prognosis
Spine
Thyroid Gland
Thyroid Neoplasms*

Figure

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  Fig. 1 Fluorodeoxyglucose-positron-emitting tomography image of (A) brain and (B) Torso. A cold spot is located on the left frontal lesion, a tumor mass uptakes glucose more than white matter, but surrounding normal gray matter more actively uptakes glucose. Papillary thyroid carcinoma is shown as hot uptake of cervical lesion in the Torso.

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  Fig. 2 The tumor growing toward mediastinum (red arrow) and retropharyngeal space and not which presenting goiter (A and D). The main mass located in deep cervical to lung apex lesion which encased major vessels and nerves, and deviated the trachea (B). Lung CT shows small nodular mass suspicious of metastasization from thyroid (C).

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  Fig. 3 Thyroid mass invaded into the vessel (arrow in A), with internal jugular venous thrombus (arrow in B) and cervical lymph node enlargement.

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  Fig. 4 Pathologic images of thyroid low magnification (A) and high magnification (B), which show irregular nuclear membrane with enlarged, grooved nucleus. Papillary thyroid carcinoma (PTC) coexisted with Hashimoto's thyroiditis (C). Metastasized cerebral tumor (D) showing same pathologic patterns as PTC. A and C: H&E, ×100. B and D: H&E, ×400.

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  Fig. 5 Brain pre-operative enhanced MRI image (A). There is a single cystic mass in left frontal lobe. But in the post-operative enhanced MRI image (B) shows total removal of left frontal mass, but additional enhanced small mass were also found in right frontal and occipital lobe during the interval of 4 weeks.

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  Fig. 6 Bone scan with Tc-99m-pertechnetate shows a defect in the left parietal bone, as sequel of the recent craniotomy surgery. There is a metastatic skeletal hot uptake lesion of lower cervical spine.

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