Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece.
Department of Endocrinology, University Hospital of Crete, Heraklion, Crete, Greece.
Am J Case Rep. 2023 Oct 19;24:e939025. doi: 10.12659/AJCR.939025.
BACKGROUND Brain metastasis of papillary thyroid cancer (PTC) is rare. Treatment of these patients is challenging due to the lack of specific guidelines. Early diagnosis is accompanied by immediate treatment and less morbidity. Total resection of brain lesions may be unattainable when they include infiltration of eloquent areas. This report is of an 81-year-old man who had undergone total thyroidectomy for goiter in the past and presented with metastatic papillary thyroid carcinoma (PTC) to the neck after a gap of 16 years. After two years, the patient developed a solitary cystic brain PTC metastasis associated with raised thyroglobulin (Tg) inside the cystic lesion aspirated during brain surgery. CASE REPORT An 81-year-old male patient was admitted for a space-occupying brain lesion in the right frontal lobe. The patient's history included metastatic disease of PTC to the neck with cervical lymph node metastasis and local recurrence after surgery and radioactive iodine-131 treatment. The patient underwent craniotomy and removal of the lesion. The aspirated fluid was sent for cytological examination and measurement of Tg levels, which were interestingly high. Pathology of the brain lesion revealed infiltration of brain parenchyma from a metastatic lesion characterized by eosinophilic cells with irregular contours forming grooves, resulting in cytoplasmic pseudo-inclusions, an oncotic variant of PTC. CONCLUSIONS This report has shown that residual tissue may be present following total thyroidectomy and may be the origin of PTC with metastasis to the brain. The patient in this study suffered from a brain lesion that could be excised. However, aspiration of cystic compartments could provide a rapid diagnosis in patients with non-removable brain lesions.
甲状腺乳头状癌（PTC）脑转移较为罕见。由于缺乏特异性指南，这些患者的治疗颇具挑战性。早期诊断伴即刻治疗可降低发病率。当病变累及语言功能区时，完全切除脑转移病灶可能无法实现。本文报告了 1 例 81 岁男性患者，其曾因甲状腺肿行甲状腺全切除术，16 年后因颈部转移性 PTC 就诊。2 年后，患者出现单发囊性脑 PTC 转移，囊性病变内的甲状腺球蛋白（Tg）升高，在脑外科手术中抽吸囊性病变。
1 例 81 岁男性患者因右额叶占位性病变入院。该患者病史包括 PTC 颈部转移伴颈淋巴结转移和手术及放射性碘-131 治疗后的局部复发。患者接受了开颅手术和病变切除。抽吸的液体被送检细胞学检查和 Tg 水平测量，结果很有趣，Tg 水平升高。脑病变的病理显示，脑实质浸润源于转移病变，表现为轮廓不规则的嗜酸性细胞，形成沟，导致细胞质假包涵体，这是 PTC 的一种胶样变体。
本报告表明，甲状腺全切除术后可能存在残留组织，可能是 PTC 伴脑转移的起源。本研究中的患者患有可切除的脑病变。然而，对于无法切除的脑病变患者，抽吸囊性隔室可提供快速诊断。
