Follicular Carcinoma of Thyroid Presenting As Brain Metastasis

Romanian Neurosurgery (2015) XXIX 3: 373 - 375 373
Follicular carcinoma of thyroid presenting as brain

metastasis
Bhavana Grandhi1, Byna Syamasundara2, Amit Agarwal3,

P. Umamaheshwara Reddy4
Narayana Medical College and Hospital, Nellore, Andhra Pradesh
1
Assistant Professor, Department of Pathology; 2Associate Professor, Department of Pathology;
3
Professor, Department of Neurosurgery; 4Assistant Professor, Department of Radiology
Abstract: Metastatic brain tumors are a major cause of mortality in cancer patients. The
primary tumor is most commonly seen in the lung, breast, colon and kidney and very
rarely in the thyroid. We discuss a case of a 55year old lady with presenting complaints
of seizures. There is a past history of carcinoma thyroid for which she had underwent
total thyroidectomy. Craniotomy was done and histopathological examination revealed
metastatic deposits from follicular carcinoma thyroid.
Key words: Brain tumors, Follicular carcinoma, Metastasis, Thyroid.
Introduction thyroidectomy was done twenty years back.

Left parasagittal craniotomy was done with
Brain masses are mostly metastatic in origin,
tumour excision and the specimen was sent for
accounting for more than 50% of hospital histopathological examination. Microscopic
admissions for brain tumors. The most common examination revealed glial tissue with adjacent
primary sites are tumors from the lung, breast, tumor tissue showing well-formed follicles
colon, kidney (2). Follicular carcinoma of lined by epithelium showing nuclear atypia.
thyroid is the second most common thyroid Vascular invasion also seen and the diagnosis
malignancy with distant metastasis to bone, of metastatic deposits, probably of follicular
lungs, and rarely to the brain, skin and adrenals. carcinoma thyroid was given.
(1) Most of the CNS tumors are symptomatic at
the time of diagnosis with most common being Discussion
seizures and localized motor deficits. (3, 4) We Brain metastasis is seen in 16-18% of
report a case of a 55yr old female who presented cancer patients and in about 9% cases, it
to the Neurosurgery OPD with seizures and was represents the only site of cancer. The
diagnosed, metastasis from Follicular carcinoma intracranial compartment is of particular
thyroid. interest as most of the foci are symptomatic
Case history with highly lethal manifestations if left
A 55 year old female came to the untreated. (8) Hematogenous spread is
emergency with history of seizures. MRI brain commonest route spread. The acute angle of
was done showing parasagittal hypodense the branching of pulmonary vessels makes the
lesion and was admitted under Neurosurgery corticomedullary gray white junction, the
with a provisional diagnosis of Meningioma or commonest site of metastasis within the brain
Secondary deposits. Previous history of parenchyma. (5) Metastasis from thyroid
Carcinoma thyroid for which total
carcinoma is rare and accounts for 0.1-5% of
374 Grandhi et al Follicular carcinoma of thyroid presenting as brain metastasis
cases in the reported series. Thyroid carcinoma

is divided into 3 types, follicular, papillary and
anaplastic carcinoma. The metastatic potential
is a function of the tumour size, capsular and
vascular invasion. (8) Disseminated metastasis
as an initial presentation is very rare in
follicular thyroid carcinoma. (2) Brain
metastasis has been reported from thyroid
adenomatous nodules. (7) Distant metastasis
from follicular thyroid carcinoma to the
lumbar vertebrae, skull bone and meninges
have been documented. (6) Mc. William et al
published the largest series of metastatic
thyroid carcinoma to brain with 16 patients, Figure 2 A - Normal glial tissue with adjacent tumor
out of which only two of them were diagnosed tissue (Hematoxylin and eosin, scanner view)
as follicular thyroid cancer which speaks about
its rarity. (8)
Thus, we report this case because of its rare
occurrence.
Figure 2 B - Tumor tissue composed of thyroid

follicles filled with colloid (Hematoxylin and eosin,
10X)
Figure 1 - Axial T2W images (A, B, C) showing

well defined iso-hypointense extra-axial lesion in left
parafalcine location with extensive vasogenic edema.
On susceptibility weighted images (D) there was no
blooming, diffusion weighted images and
corresponding ADC map (E, F) show no restriction
within the lesion
Figure 2 C - Tumor cells with hyperchromatic nuclei

and moderate amount of cytoplasm. (Hematoxylin
and eosin, 40X)
Romanian Neurosurgery (2015) XXIX 3: 373 - 375 375
Conclusion 3. Kamar FG, Posner JB. Brain metastases. Semin Neurol

2010;30:217-35.
Follicular carcinoma of thyroid is a rare 4. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom
tumour that presents with cerebral metastasis WM, Hanssens PE, Schmitz PI. Identification of
and thyroid carcinoma should be considered in prognostic factors in patients with brain metastases: A
review of 1292 patients. Int J Radiat Oncol Biol
the differential diagnosis of contrast enhancing Phys1999;43:795-803.
mass lesions in the CNS. 5. Melike Pekmezci, Arie Perry Neuropathology of brain
metastases SNI: Neuro-Oncology 2013, Vol 4, Suppl 4 -
Correspondence A Supplement to Surgical Neurology International.
Dr. Bhavana Grandhi 6. P. Krishnappa, S. Ramakrishnappa, M. Kulkarni, S.
1/1278, Nawabpeta, Bunglathota Giriyan. Follicular carcinoma of the thyroid presenting as
Nellore Andhra Pradesh, India distant metastasis: A case report and review of literature.
The Internet Journal of Laboratory Medicine. 2012;5(1).
Mobile: 9642111209
7. Tadashi Terada: Brain metastasis from thyroid
E-mail: [email protected] adenomatous nodules or an encapsulated thyroid
follicular tumor without capsular and vascular invasion: a
References case report. Cases Journal 2009, 2:7180.
8. Yusuf, Engin, Doga, Erol, Turkish Neurosurgery 2005,
1. Alper Sevinc, Follicular thyroid cancer presenting
Vol: 15, No: 3, 132-135Brain Metastasis From Follicular
initially with soft tissue metastasis. Jpn J.Clin.Oncol
Thyroid Carcinoma: Case report and Literature Review.
2003;30(1)27-29.
2. Douglas C Miller. Metastatic neoplasms in brain
parenchyma In. Modern Surgical Pathology. New York:
Cambridge University Press, 2009;206-207.

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Romanian Neurosurgery (2015) XXIX 3: 373 - 375 373

Follicular carcinoma of thyroid presenting as brain

Bhavana Grandhi1, Byna Syamasundara2, Amit Agarwal3,

Introduction thyroidectomy was done twenty years back.

cases in the reported series. Thyroid carcinoma

Figure 2 B - Tumor tissue composed of thyroid

Figure 1 - Axial T2W images (A, B, C) showing

Figure 2 C - Tumor cells with hyperchromatic nuclei

Conclusion 3. Kamar FG, Posner JB. Brain metastases. Semin Neurol

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