Solitary follicular thyroid carcinoma of the skull base and its differentiation from ectopic adenoma — review, use of galectin-3 and report of a new case

With only four histologically proven cases in the literature, solitary skull base metastasis of thyroid carcinoma is extremely rare. Having treated another patient harboring a lesion with osseous destruction in the petroclival region and downward soft tissue extension we analyzed this case in conjunction with previous reports. In contrast to parenchymal brain metastasis that usually consists of the papillary type, histological examination revealed differentiated follicular tumors in all cases. All were located around the clivus. The radiographic picture resembled that of chordomas or chondrosarcomas. In the tissue obtained during thyroidectomy no evidence of primary malignancy was found in any of the cases according to standard histological criteria. In our case, a recently developed immunocytological marker – galectin-3 – was applied to differentiate between ectopic thyroid adenoma and carcinoma. The results were indicative of anaplastic growth. Tumor remnants responded well to postoperative 131I internal radiation and TSH suppression therapy. Distant metastasis of follicular thyroid carcinoma has to be considered in the differential diagnosis of destructive skull base lesions. Histological evaluation should include immunohistochemistry or clonal analysis to differentiate between adenomatous and carcinomatous growth and initiate effective radiotherapy early. Prognosis is by far not as poor as in brain metastases and appears to depend largely on location, size and histological appearance.