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04 September 2023 : Case report  Greece

[In Press] Thyroglobulin as a Rapid and Cost-Effective Biomarker for Diagnosis of Thyroid Carcinoma Brain Metastasis: A Case Report of a Patient with Metastatic Hurthle Cell Thyroid Carcinoma

Unusual clinical course, Unusual setting of medical care

Konstantinos Ntotsikas1ABEF, Sofia Lazarioti1ABDEF, Vasiliki Daraki2ACE, Elias Drakos34BD, Panagiotis-Nikolaos Tsakalomatis ORCID logo2ABCDEF, Eleni-Konstantina Syntzanaki2BD, Nikolaos Moustakis ORCID logo1ABDE, Anastasios I. Marinis1ABDE, Aris Salapatas-Gkinis4ABD, Paraskevi Xekouki24AE, Antonis Vakis14ABE, Christos Tsitsipanis14ABDEF

DOI: 10.12659/AJCR.939025

Am J Case Rep In Press; DOI: 10.12659/AJCR.939025  

Available online: 2023-09-04, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Brain metastasis of papillary thyroid cancer (PTC) is rare. Treatment of these patients is challenging due to the lack of specific guidelines. Early diagnosis is accompanied by immediate treatment and less morbidity. Total resection of brain lesions may be unattainable when they include infiltration of eloquent areas. This report is of an 81-year-old man who had undergone total thyroidectomy for goiter in the past and presented with metastatic papillary thyroid carcinoma (PTC) to the neck after a gap of 16 years. After two years, the patient developed a solitary cystic brain PTC metastasis associated with raised thyroglobulin (Tg) inside the cystic lesion aspirated during brain surgery.
An 81-year-old male patient was admitted for a space-occupying brain lesion in the right frontal lobe. The patient’s history included metastatic disease of PTC to the neck with cervical lymph node metastasis and local recurrence after surgery and radioactive iodine-131 treatment. The patient underwent craniotomy and removal of the lesion. The aspirated fluid was sent for cytological examination and measurement of Tg levels, which were interestingly high. Pathology of the brain lesion revealed infiltration of brain parenchyma from a metastatic lesion characterized by eosinophilic cells with irregular contours forming grooves, resulting in cytoplasmic pseudo-inclusions, an oncotic variant of PTC.
This report has shown that residual tissue may be present following total thyroidectomy and may be the origin of PTC with metastasis to the brain. The patient in this study suffered from a brain lesion that could be excised. However, aspiration of cystic compartments could provide a rapid diagnosis in patients with non-removable brain lesions.

Keywords: Biopsy, Fine-Needle; Brain Neoplasms; Lymphatic Metastasis; TG Protein, Human; Thyroid Cancer, Hurthle Cell

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923