A ‘silent’ skull metastatic follicular thyroid carcinoma mimicking as a benign scalp tumor in a pregnant woman

[摘要] Thyroid cancer with cranial metastasis in a pregnant woman is very rare. In the literature, most cases are diagnosed earlyfrom neurogenic signs or symptomatic thyroid gland. Pregnancy also contributes to a hesitation toward early surgicaland medical treatments. We reported a scalp tumor in a physically healthy 37-year-old pregnant female with a follicularthyroid carcinoma (FTC) with lung, bone and cranial metastasis in initial presentation. Silent neurogenic and physicalexaminations make an early diagnosis very challenging. Resection of scalp and intracranial tumor, a thyroidectomy,post-operative radioactive iodine therapy and tyrosine kinase inhibitors were employed as treatment. The scalp tumorwas confirmed as a metastatic follicular thyroid carcinoma via positive immunoreactivity for thyroglobulin and thyroidtranscription factor 1 in tumor cells. Blood examination revealed an elevated thyroglobulin level (>5335ng/mL). Thepatient was discharged without any neurological deficit. An asymptomatic scalp tumor in a pregnant woman with anormal thyroid disease history needs differential diagnosis from intracranial origin. Rapid progression and an elevatedthyroglobulin level are the indicators that further image study is needed. Aggressive surgical excision of resectablethyroid gland and metastatic tumor are essential for a longer survival rate. There is nothing to indicate that a postpartum operation will worsen prognosis.

[学科分类] 血液学