Akdemir Ismail, Erol Fatih S, Akpolat Nusret, Ozveren M Faik, Akfirat Murat, Yahsi Seyfettin
Department of Neurosurgery, Firat University School of Medicine, 23100 Elazig, Turkey.
Neurol Med Chir (Tokyo). 2005 Apr;45(4):205-8. doi: 10.2176/nmc.45.205.
A 57-year-old male patient presented with an immobile ellipsoid mass of 6-cm diameter in the right occipitoparietal region. Cranial computed tomography showed the mass with dense contrast enhancement causing bone destruction. After embolization of the mass, total resection was performed. Histological examination showed the mass had a capsule, with no invasion of the dura mater or dermis, and the follicles of various sizes covered with mono-lined thyrocytes were full of colloid. Immunohistochemical examination showed positive staining for thyroglobulin. Postoperatively, levels of thyroid hormones were normal, and thyroid ultrasonography and technetium-99m scintigraphy showed no abnormalities. Fine needle aspiration biopsy performed at various locations of the thyroid gland revealed no atypical thyroid cells. Whole body technetium-99m scintigraphy found no abnormal bone involvement. The histological evidence was suggestive of follicular carcinoma metastasis. Surgical treatment was planned for the thyroid gland, but the patient did not consent. Two years later, the patient presented with the pain and sensitivity in the sacrum, the right iliac wing, and the right caput femoris. Computed tomography revealed lytic lesions in these areas. Bone metastases were identified. Whole body scintigraphy showed increased activity in these regions, but the cranium and all other tissues were normal. The patient underwent total thyroidectomy under a diagnosis of follicular carcinoma. The present case of a lytic skull lesion associated with normal thyroid tissue on admission but finally treated as follicular thyroid cancer emphasizes the difficulty in histological discrimination of follicular carcinoma from normal thyroid tissue.
一名57岁男性患者，右枕顶部出现一个直径6厘米的固定椭圆形肿块。头颅计算机断层扫描显示该肿块有明显的对比增强，导致骨质破坏。在对肿块进行栓塞后，进行了全切除。组织学检查显示肿块有包膜，未侵犯硬脑膜或真皮，大小各异的滤泡被单层甲状腺细胞覆盖，充满胶质。免疫组织化学检查显示甲状腺球蛋白染色阳性。术后，甲状腺激素水平正常，甲状腺超声和锝-99m闪烁扫描均未显示异常。在甲状腺不同部位进行的细针穿刺活检未发现非典型甲状腺细胞。全身锝-99m闪烁扫描未发现骨骼受累异常。组织学证据提示为滤泡癌转移。计划对甲状腺进行手术治疗，但患者不同意。两年后，患者出现骶骨、右髂骨翼和右股骨头疼痛及压痛。计算机断层扫描显示这些部位有溶骨性病变。确诊为骨转移。全身闪烁扫描显示这些区域放射性增高，但颅骨和所有其他组织正常。患者在诊断为滤泡癌后接受了甲状腺全切除术。本例入院时颅骨溶骨性病变与正常甲状腺组织相关，但最终被诊断为滤泡状甲状腺癌，强调了滤泡癌与正常甲状腺组织在组织学鉴别上的困难。
