Management considerations for differentiated thyroid carcinoma presenting as a metastasis to the skull base

被引:14
|
作者
Mydlarz, Wojeiech K.
Wu, Julie
Aygun, Nafi
Olivi, Alessandro
Carey, John P.
Westra, William H.
Tufano, Ralph P.
机构
[1] Johns Hopkins Univ, Sch Med, Dept Otolaryngol Head & Neck Surg, Baltimore, MD 21287 USA
[2] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21287 USA
[3] Johns Hopkins Univ, Sch Med, Dept Radiol, Baltimore, MD 21287 USA
[4] Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21287 USA
来源
LARYNGOSCOPE | 2007年 / 117卷 / 07期
关键词
differentiated thyroid carcinoma; follicular carcinoma; papillary carcinoma; metastasis; skull base; clivus; cavernous sinus; sella turcica; pituitary; petrous bone; diagnosis; prognosis; management;
D O I
10.1097/MLG.0b013e318058192e
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Objectives/Hypothesis: To characterize the salient features of skull base metastasis from differentiated thyroid carcinoma, discuss the diagnostic and treatment strategies, and propose rational management guidelines for such tumors. Study Design: Case report. Methods: Review of English literature from MEDLINE with the addition of our case. Results: Skull base metastasis from differentiated thyroid carcinoma is rare, with only 20 cases reported to date, including our case report. On the basis of a review of all reported cases, both follicular and papillary thyroid cancers can metastasize to the skull base. Our case is unique because the lesion extends locally into the cavernous sinus and beyond. Histopathologic diagnosis is limited by the remote location of lesions. Most tumors are highly vascular, and there is potential for significant morbidity and mortality associated with surgical resection. The overall survival ranges from less than one year to 10+ years from the discovery of the metastasis and is similar in both tumor subtypes. There is no clear consensus on the management strategy for skull base metastasis from differentiated thyroid carcinoma. Interestingly, surgical resection of both the primary and metastatic lesions yields similar survival when compared with resection of the primary tumor alone. Conclusions: Distant metastasis from differentiated thyroid carcinoma needs to be considered in the differential diagnosis of destructive skull base lesions, regardless of the patient's age. Histopathologic tissue diagnosis should always be attempted, followed by total thyroidectomy, radioiodine, or external beam radiation, and chronic thyroid-stimulating hormone suppression. Surgical resection of the metastatic lesion should only be performed in carefully selected cases because it is associated with significant morbidity.
引用
收藏
页码:1146 / 1152
页数:7
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