Endocrine Abstracts

Background: Thyroid carcinoma has increased annually. Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and thought to have favourable prognosis. Distant metastases are common in lungs and bones. However, brain metastases are rare and its prognosis is unfavourable. Here we reported a case of solitary brain metastases of PTC mimicking cavernous angioma in a 76-year-old woman patient.

Methods: We collected her data retrospectively.

Results: A 76-year-old woman presented memory disturbance for 3 months. On physical examination, there was a 5 cm sized mass without tenderness in sternum. The brain magnetic resonance image showed a lobulated lesion with a mixed signal core surrounded by low intensity rim in right frontal lobe that was not enhanced in contrast image suitable for a cavernous angioma with haemorrhage. There was a mass with necrosis in the manubrium on chest computed tomography (CT) but no abnormality in abdomen CT. We did craniotomy for tumour removal and manubrium mass biopsy in the same day. In pathological finding, brain and manubrium revealed metastatic carcinoma consistent with primary in thyroid. For investigation of thyroid cancer, we did a neck ultrasonography and it demonstrated 1 cm sized hypoechoic nodule with coarse calcification in the left isthmus. As a result of fine needle aspiration on left thyroid nodule, pathology showed a classic PTC and BRAF mutation was positive. The patient refused thyroidectomy and expired 9 months later due to pneumonia and sepsis.

Conclusion: Brain metastases with PTC mimicking cavernous angioma is extremely rare. It makes us cautious that even small PTC could occur as distant metastasis.