Large skull metastasis of follicular thyroid carcinoma.

DESCRIPTION A 62-year-old woman presented with gradual enlargement of a tumour mass on her head. She had fi rst noticed it about 2 years previously, but it had started to enlarge several months before she came to our clinic. She was alert but reported mild headache and nausea. We found a large soft and elastic tumour on the left temporal and occipital region of her head. Thyroid tumour was undetected on palpation. Head CT and brain MRI revealed a large tumour; three-dimensional CT showed skull bone destruction ( fi gure 1 ). CT also revealed a calcifi ed tumour in the right thyroid lobe, small granular pulmonary shadows and osteolysis in the right pubic bone ( fi gure 2 ). Based on fi ne-needle aspiration biopsy (FNAB) of the thyroid tumour, follicular neoplasm was suspected. Serum thyroglobulin level was 89 177.1 ng/ ml (0.0–100.0 ng/ml). We performed tumourectomy of the head and total thyroidectomy. Histopathological examination showed follicular thyroid carcinoma (FTC) with skull metastasis ( fi gure 3 ). Following surgery, the patient’s serum thyroglobulin level was reduced to 22 932.3 ng/ml and her headache and nausea disappeared. She experienced no disorientation, paralysis or gait disorder and at follow-up 1-year after surgery she was asymptomatic.