Endocrine Abstracts

Papillary thyroid carcinoma is a disease associated with a very good prognosis. However, there are some subtypes of papillary thyroid cancer which are associated with aggressive biological behavior and worse outcome. The appearance of brain metastatic disease in the course of papillary thyroid carcinoma is rare and carries an unfavorable prognosis.

The aim was to describe the case of a patient with tall cell papillary thyroid carcinoma who presented with brain metastatic disease.

A patient, male, aged 63 years, presented with a large mass in the area of the thyroid causing dysphagia. Initial evaluation with thyroid hormone measurement and a fine needle aspiration biopsy revealed the presence of malignancy. Near total thyroidectomy was performed. On histology a large tumor measuring 7.0×7.0×5.0 cm and weighing 122 g was examined. The tumor was multilobular, scleroelastic and had a small area of fibrosis and an area of cystic degeneration. The neoplasm was a tall cell papillary thyroid carcinoma which had foci of dedifferentiation. Within the area of low differentiation atypical mitoses were observed with a Ki67 index of approximately 10%. The tumor was positive to p53 in 50% of the cells. Extrathyroidal extension was observed. After near total thyroidectomy therapeutic radiodine was administered. Approximately a year later the patient presented with brain metastases.

Brain metastatic disease from thyroid cancer is rare and carries a bad prognosis. Some subtypes of papillary thyroid cancer, such as the tall cell variant have an increased propensity to develop metastatic disease, including brain metastatic disease. In conclusion, the case of a patient with a tall cell thyroid carcinoma with areas of low differentiation is presented who developed early brain metastatic disease.