Papillary carcinoma of the thyroid with distant metastases to the cerebrum: a case report

Cerebral metastases from papillary carcinoma of the thyroid are a very unco mmon condition, but such metastases behave more aggressively and show poor prognosis. These metastases almost always involve concomitant lung or bone metastases which may be the first metastatic sites. Here we report a 53-yea r-old man with diffuse goiter and cervical lymphadenopathy who developed sy mptoms of elevated intracranial pressure. Computed tomography demonstrated ring-enhanced lesions showing a severe mass effect in the right cerebrum an d a nodule in the right thyroid gland accompanied by swollen lymph nodes. B iopsied specimens of the thyroid nodule demonstrated malignant cells of pap illary carcinoma. Surgical excision of the metastatic brain lesions was fol lowed by total thyroidectomy with regional lymphadenectomy. Histological ex aminations confirmed that the patient had cerebral metastases from papillar y carcinoma of the thyroid without other distant metastasis. Neurological a bnormality disappeared after surgery and treatment with radioactive iodine (I-131) and oral thyroxine were initiated thereafter. This case suggests th at the thyroid gland is potentially a primary source of metastatic brain ca rcinoma. Moreover, early detection of cerebral metastases is crucial becaus e these metastatic lesions can be life threatening, in contrast to the rela tively less severe clinical course of this malignancy unless it is associat ed with any distant metastasis.