Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India.
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India.
Pan Afr Med J. 2023 May 5;45:20. doi: 10.11604/pamj.2023.45.20.40017. eCollection 2023.
Papillary thyroid carcinoma is one of the most common thyroid malignancy, often has excellent prognosis and low incidence of distant metastatic conditions. Brain metastases from papillary thyroid carcinoma has a rare occurrence, with patients presenting with non-specific symptoms such as headaches, cognitive changes etc., and poor survival outcomes. The standard protocol for diagnosis and treatment remains controversial. We report a patient who presented with cerebral metastasis prior to the diagnosis of papillary thyroid carcinoma, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. A 60-year-old hypertensive male presented with lower back pain, bilateral lower limb weakness, occasional episodes of frontal headache and personality changes. The diagnostic evaluation included computed tomography (CT) scan, magnetic resonance imaging (MRI) with and without contrast enhancement, and color Doppler. Intra-axial complex solid cystic mass lesion in the right parieto-occipital region with significant perilesional oedema, and imaging characteristic of neoplastic etiology were observed. He was posted for excision of tumor and underwent right occipital craniotomy. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. Brain metastases from thyroid malignancy is a sign of detrimental prognosis, hence, thorough clinical, radiological and pathological evaluation for rapid detection is critical. Neurosurgical removal along with radiotherapy should be considered as treatment of choice. The information obtained contributes towards better management and overall long-term outcomes.
甲状腺乳头状癌是最常见的甲状腺恶性肿瘤之一，通常具有良好的预后和低远处转移的情况。甲状腺乳头状癌脑转移的发生率较低，患者表现为头痛、认知改变等非特异性症状，且生存结局较差。诊断和治疗的标准方案仍存在争议。我们报告了一例在诊断甲状腺乳头状癌之前出现脑转移的患者，根据临床、病理和影像学数据，回顾了目前的文献并解释了我们的治疗方法。一名 60 岁的高血压男性因腰痛、双侧下肢无力、偶有额头痛和人格改变而就诊。诊断评估包括计算机断层扫描（CT）、磁共振成像（MRI）加和不加对比增强以及彩色多普勒。观察到右顶枕叶区有一个大的、有显著周边水肿的、具有肿瘤病因影像学特征的、复杂的、实质-囊性、跨脑叶的肿块。他被安排进行肿瘤切除，并接受了右枕骨开颅术。手术标本的组织病理学分析证实为甲状腺乳头状癌。甲状腺恶性肿瘤的脑转移是预后不良的标志，因此，快速检测需要进行全面的临床、影像学和病理学评估。神经外科切除联合放疗应作为治疗的首选。所获得的信息有助于更好的管理和长期预后。
