METASTATIC FOLLICULAR THYROID-CARCINOMA MASQUERADING AS A CHORDOMA

A 61-year-old Caucasian man presented with otalgia, dysarthria, and we ight loss, Neurological examination revealed palatal hypomotility, and weakness of the facial and tongue muscles. Magnetic resonance imaging of the head demonstrated the presence of a soft tissue mass in the cl ivus, Histologic examination of resected tumor disclosed well-differen tiated thyroid follicles that invaded the local osseous tissues, Physi cal examination and radioiodine images of the thyroid gland were norma l, The serum thyroglobulin concentration was markedly elevated (1011 n g/mL). A 0.9-cm well-differentiated benign-appearing left thyroid lobe follicular neoplasm with a thick fibrous capsule was found following diagnostic thyroidectomy, This report illustrates that clinically sign ificant distant metastases can arise from occult follicular thyroid ne oplasms that, according to standard histologic criteria, are benign, T he presence of a thick fibrous capsule, even in the absence of vascula r or capsular invasion, may identify follicular neoplasms that have me tastatic potential.