Aguiar P H, Agner C, Tavares F R, Yamaguchi N
Pinheiros Neurosurgical Clinic, São Paulo, Brazil.
Neurosurgery. 2001 Oct;49(4):1008-13. doi: 10.1097/00006123-200110000-00044.
Brain metastases from papillary carcinoma of the thyroid gland are unusual. No consensus regarding management has yet been reached. We report a case, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data.
A 33-year-old woman presented with signs of intracranial hypertension. The diagnostic evaluation included chest tomography, head computed tomography, brain magnetic resonance imaging with and without contrast enhancement, total-body scanning, and cerebral scintigraphy. Multiple supratentorial lesions and one right cerebellopontine angle lesion were observed. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland.
A ventriculoperitoneal shunt was placed and a right suboccipital craniotomy was performed, with complete removal of the cerebellopontine angle tumor. Total-brain irradiation with 40 Gy/lesion followed the initial operation. One year after surgery, the patient presented with signs of increased intracranial pressure. A new left frontal lobe lesion with massive peritumoral edema was identified on magnetic resonance imaging scans. The edema was treated clinically and a left frontal craniotomy was performed, with complete resection of the tumor. The patient is currently faring well, with residual expressive aphasia.
Surgery followed by radiotherapy seems to be a good alternative for the treatment of this specific type of metastasis. Thorough clinical and radiological evaluation, followed by genetic analysis of the surgical specimen, particularly with respect to the potential for tumor invasion under specific conditions, is recommended. The information obtained contributes to better management and better overall long-term outcomes for these patients.
甲状腺乳头状癌脑转移并不常见。目前对于其治疗尚未达成共识。我们报告一例病例，回顾当前文献，并根据临床、病理和影像学资料阐述我们的治疗方法。
一名33岁女性出现颅内高压症状。诊断评估包括胸部断层扫描、头部计算机断层扫描、有无对比增强的脑磁共振成像、全身扫描及脑闪烁显像。观察到幕上多个病灶及右侧小脑桥脑角一个病灶。手术标本的组织病理学分析证实为甲状腺乳头状癌。
置入脑室腹腔分流管并进行右枕下开颅手术，完整切除小脑桥脑角肿瘤。初次手术后进行全脑照射，剂量为40 Gy/病灶。术后一年，患者出现颅内压升高症状。磁共振成像扫描发现左额叶有一个新病灶，伴有大量瘤周水肿。对水肿进行临床治疗后进行左额叶开颅手术，完整切除肿瘤。患者目前情况良好，遗留表达性失语。
手术联合放疗似乎是治疗这种特定类型转移瘤的良好选择。建议进行全面的临床和影像学评估，随后对手术标本进行基因分析，特别是针对特定条件下肿瘤侵袭的可能性。所获得的信息有助于更好地管理这些患者并改善总体长期预后。
