Literature Review
Bilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature Guive Sharifi1, Mehrdad Hosseinzadeh Bakhtevari1, Mohsen Alghasi2, Masood Asghsri Nosari1, Ramin Rahmanzade1, Omidvar Rezaei1
Key words Choroid plexus metastasis - Intraventricular tumors - Papillary thyroid carcinoma -
- BACKGROUND:
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. It has an indolent clinical course and favorable prognosis. Brain metastasis is uncommon and complicates about 0.1%e5% of PTCs. Metastasis to the choroid plexus of the lateral ventricles has been reported in 7 cases of thyroid malignancies, all of which were unilateral.
Abbreviations and Acronyms PTC: Papillary thyroid carcinoma RCC: Renal cell carcinoma
- METHODS:
From the 1Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran; and 2Department of Neurosurgery, Firuzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
- RESULTS:
To whom correspondence should be addressed: Mehrdad Hosseinzadeh Bakhtevari, M.D. [E-mail: [email protected]]
- CONCLUSIONS:
Citation: World Neurosurg. (2015) 84, 4:1142-1146. http://dx.doi.org/10.1016/j.wneu.2015.05.027 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2015 Elsevier Inc. All rights reserved.
INTRODUCTION Intraventricular tumors may arise from the ventricular wall, adjacent cerebral structures, or extracranial neoplastic lesions. The most common intraventricular neoplastic lesions include choroid plexus papilloma and meningioma. Metastases to the ventricles are infrequent, accounting for 6% of intraventricular tumors. Renal cell carcinoma (RCC) is the most reported primary carcinoma that causes intraventricular metastasis (8, 9). Most intraventricular metastases result from hematogenous dissemination of primary tumor to the choroid plexus via the anterior or posterior choroidal artery. Metastatic lesions are most commonly (>50%) located in the trigone of lateral ventricles because of the large tufts of choroid plexus in the trigone (6, 9). Choroid plexus can be the first site of metastasis for extracranial malignancies, but involvement of the choroid plexus usually accompanies metastases to other sites. To our knowledge, among 40 cases of choroid plexus metastasis reported thus far, tumor metastasized bilaterally in only 1 case of colon adenocarcinoma (11). We present a case of bilateral
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We report a case of a 52-year-old woman with a history of PTC who presented with severe headache, nausea and vomiting, right hemiparesis, and speech disturbance. Imaging studies depicted lesions in both lateral ventricles. The patient underwent microsurgical tumor resection. Histopathologic examination revealed choroid plexus metastasis from PTC. Metastases to the choroid plexus from extracranial tumors are very rare, with only a few cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as renal cell carcinoma, for choroid plexus, especially in the lateral ventricles. We report the eighth case of choroid plexus metastasis, but it is the first bilateral one arising from thyroid cancer.
choroid plexus metastases arising from papillary thyroid carcinoma (PTC).
MATERIALS AND METHODS Case Report A 52-year-old woman presented with a 6month history of severe headache, nausea and vomiting, and speech disturbance. Neurologic examination revealed right hemiparesis and mild speech disturbance mimicking Wernicke aphasia. She had a history of PTC of classic variant diagnosed about 3 years ago, followed by thyroidectomy and radioiodine ablation therapy. Magnetic resonance imaging (MRI) depicted a well-circumscribed mass in both lateral ventricles that homogenously enhanced after gadolinium contrast administration (Figure 1). Computed tomography angiography demonstrated the lesion’s supply from anterior and posterior choroidal arteries (Figure 2). The patient underwent craniotomy through a posterior intraparietal parasagittal approach to avoid passing the optic
radiation and to avoid the language areas covering the left trigone. Microsurgical tumor resection was performed and a left lateral ventricle tumor was excised. It was a hypervascular mass that caused a large hemorrhage during surgery (Figure 3). Because of mild intraoperative intraventricular bleeding, an external ventricular drain was placed at the time of surgery for postoperative pressure monitoring. The drain was removed on the second postoperative day when normal intracranial pressure was measured. Histopathology demonstrated choroid plexus metastasis from PTC (Figure 4). Postoperatively, the patient awoke without deficit and was discharged after 5 days in good condition. Postoperative MRI revealed total resection of the left lateral ventricle metastasis (Figure 5). The patient received radiation therapy and iodine-131 radioiodine ablation therapy for the contralateral ventricular tumor. Follow-up MRI 6 months after radioiodine therapy revealed shrinkage of the right-side metastasis, and no recurrence was detected (Figure 6).
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2015.05.027
LITERATURE REVIEW GUIVE SHARIFI ET AL.
Figure 1. Magnetic resonance imaging shows well-circumscribed mass in both lateral ventricles and a cortical mass lesion in the right hemisphere.
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
T1-weighted (A) and T2-weighted (B) images were homogeneously enhanced after gadolinium contrast administration (C and D).
DISCUSSION
Figure 2. Computed tomography angiography demonstrated the lesion’s supply from the anterior and posterior choroidal arteries.
Figure 3. Intraoperative photograph shows posterior parietal parasagittal approach. Microsurgical tumor resection was performed, and a left lateral ventricle tumor was excised.
WORLD NEUROSURGERY 84 [4]: 1142-1146, OCTOBER 2015
Tumor spread to the choroid plexus may occur through a hematogenous route via the anterior or posterior choroidal arteries or through cerebrospinal fluid seeding. Tumors most likely to metastasize to the choroid plexus are RCC and lung adenocarcinoma. Other tumors with documented spread to the choroid plexus include colon, stomach, breast, thyroid, bladder, melanoma, and lymphoma. In pediatric patients, metastases to the choroid plexus have been reported to arise from Wilms tumor, neuroblastoma, and retinoblastoma. PTC is the most common form of welldifferentiated thyroid cancer and the most common form of thyroid cancer to result from exposure to radiation. Papillary carcinoma appears as an irregular solid or cystic mass or nodule in a normal thyroid parenchyma. Papillary/follicular carcinoma is considered a variant of PTC (mixed form). Despite its well-differentiated characteristics, papillary carcinoma may be overtly or minimally invasive. These tumors may spread easily to other organs. Papillary tumors have a propensity to invade lymphatics but are less likely to invade blood vessels. The life expectancy of patients with this cancer is related to their age. The prognosis is better for younger patients than for patients who are >45 years old. Of patients with papillary cancers, about 11% present with metastases outside the neck and mediastinum. There are different types of thyroid carcinomas with different clinical courses, prognoses, and survival rates. PTC is the most common type (70%e90%). A welldifferentiated, slow-growing thyroid cancer
www.WORLDNEUROSURGERY.org
1143
LITERATURE REVIEW GUIVE SHARIFI ET AL.
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
Figure 4. Histopathology demonstrated metastasis from papillary thyroid carcinoma and showed a papillary tumor with cytomorphologic
characteristics of papillary carcinoma ground-glass nuclei (long arrow) and grooves (short arrow).
Figure 5. Postoperative magnetic resonance imaging with contrast enhancement revealed complete resection of the mass.
Figure 6. Follow-up magnetic resonance imaging 6 months after radioiodine therapy revealed shrinkage of the right-side metastasis. L, left; R, right.
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WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2015.05.027
LITERATURE REVIEW
WORLD NEUROSURGERY 84 [4]: 1142-1146, OCTOBER 2015
OP: posterior parietal parasagittal approach and microsurgical tumor resection
I, iodine-131; PET, positron emission tomography. 131
PTC, papillary thyroid carcinoma; OP, operative approach; M, male; F, female; *The article is in Spanish, and we did not have access to its data. yChoroid plexus metastasis was the first presentation of thyroid carcinoma.
PTC
Both lateral ventricles 52/F Sharifi et al., 2015 (present study)
36
Incidentally detected on PET scan PTC (Hürthle cell variant)
Left trigone 70/F Healy et al., 2014 (4)
6
Severe headache, nausea and vomiting, speech disturbance
24
OP: Gamma Knife radiosurgery and surgical resection
I scan OP: Gamma Knife stereotactic radiosurgery
131
PTC
Left trigone 62/M Manzil et al., 2014 (7)
Incidentally detected on posteradioiodine therapy whole-body
Open biopsy (parietal transcortical) and radiation therapy 8 Vertigo, memory loss, clumsiness in the left hand —y Thyroid carcinoma 74/F Kitagawa et al., 2013 (6)
Right trigone
OP: parieto-occipital craniotomy and resection 2 Confusion, ataxia, dysarthria, urinary incontinence 36 PTC 88/M Heery et al., 2012 (5)
Left occipital horn
OP: occipital transcortical approach 8 Severe headache, nausea, vomiting 24 75/M Wasita et al., 2010 (12)
PTC (conventional variant)
Follicular thyroid carcinoma Right trigone and multifocal PTC (follicular variant) 62/M Zhang et al., 2009 (13)
Right trigone
OP: transcallosal subtotal excision Progressive short-term memory loss —y
12
OP: parieto-occipital craniotomy and resection Severe headache, nausea PTC (tall cell variant)
Occipital horn
24
6
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
Ferrer García et al., 2002 (2)*
Presenting Symptoms Interval (months) Location of Metastasis Histopathology of Primary Tumor Age (years)/Sex Authors, year
Table 1. Literature Review of 8 Cases of Choroid Plexus Metastasis from Thyroid Cancer
Duration (weeks)
Management
GUIVE SHARIFI ET AL.
with a benign clinical course, PTC is usually diagnosed (>80%) in early stages after a latency period of 10e20 years. It has a 10-year survival rate of 90%e95% (1). PTC usually metastasizes through the lymphatic route to cervical lymph nodes, although hematogenous spread to uncommon metastatic sites is possible, especially if treatment has been inadequate. Distant metastases at the time of diagnosis is rare. If distant metastasis is present, it mainly involves lung and bone and worsens the prognosis. Brain metastases constitute 0.1%e5% of PTCs and are associated with a median survival of 12.4 months (1). PTCs are classified into histopathologic variants based on growth patterns, cell types, and stromal changes (10). Some variants, such as tall cell variant, are more aggressive and appear to have more susceptibility to metastasis to the rare secondary sites, although less aggressive variants of PTC, such as conventional variant, also can metastasize to uncommon sites, especially if treatment was inadequate (2, 3, 10). A combination of duration of spread, biologic nature of variants, and “seed and soil” relationship between metastatic cells and the secondary site (e.g., choroid plexus) appears to play a role. For example, the higher rate of choroid plexus metastases from kidney (40%) versus lung (7.5%) with consideration of the point that brain metastases mostly arise from lung (approximately 40%e50%) versus kidney (approximately 5%e10%) demonstrates that RCCs have a higher propensity to the choroid plexus versus cerebral parenchyma compared with lung carcinoma (8). Differential diagnoses of bilateral choroid plexus tumors of lateral ventricles in the literature include choroid plexus papilloma; choroid plexus carcinoma; xanthogranuloma; and metastasis from colon, RCC, and lung adenocarcinoma. One interesting point of this case was the bilateral manifestation of metastasis, which is now in the differential diagnosis of bilateral choroid plexus tumors. There is a higher rate of choroid plexus metastases from slow-growing subtypes that have an indolent course versus aggressive ones; this is seen in thyroid carcinomas (Table 1) and RCCs and suggests the duration of spread as an important factor playing a role in choroid plexus metastases (12). Metastases from
www.WORLDNEUROSURGERY.org
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LITERATURE REVIEW GUIVE SHARIFI ET AL.
thyroid cancer to the choroid plexus are extremely rare; the previously reported 7 cases are summarized in Table 1. Because of the small number of reported cases of intraventricular metastases, there is no established treatment protocol. Different treatment modalities and surgical approaches are reported. In studies reporting surgical treatment, surgery is emphasized as an important part of treatment that significantly increases survival (9, 13). Nonsurgical treatments for intraventricular metastases arising from thyroid carcinomas include wholebrain radiation therapy and radioiodine therapy. A combination of surgical and nonsurgical modalities seems to result in a better survival. CONCLUSIONS Metastases to the choroid plexus from extracranial tumors are very rare, with only 40 cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as RCC, for choroid plexus. We report the eighth case of choroid plexus metastasis arising from thyroid cancer. Although it is rare, choroid plexus metastasis from PTC must be included in the list of differential diagnoses for intraventricular tumors, especially in patients with a past history of PTC.
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
REFERENCES 1. Al-Anazi A, Shannon P, Guha A: Solitary metastasis to the choroid plexus. Case illustration. J Neurosurg 92:506, 2000.
9. McWilliams RR, Giannini C, Hay ID, Atkinson JL, Stafford SL, Buckner JC: Management of brain metastases from thyroid carcinoma: a study of 16 pathologically confirmed cases over 25 years. Cancer 98:356-362, 2003.
2. Ferrer García JC, Merino Torres JF, Ponce Marco JL, Piñón Sellés F: Unusual metastasis of differentiated thyroid carcinoma [in Spanish]. An Med Interna 19:579-582, 2002.
10. Lloyd RV, Buehler D, Khanafshar E: Papillary thyroid carcinoma variants. Head Neck Pathol 5: 51-56, 2011.
3. Hassaneen W, Suki D, Salaskar AL, Wildrick DM, Lang FF, Fuller GN, Sawaya R: Surgical management of lateral-ventricle metastases: report of 29 cases in a single-institution experience. J Neurosurg 112:1046-1055, 2010.
11. Tsuda K, Tsurushima H, Takano S, Tsuboi K, Matsumura A: Brain metastasis from papillary thyroid carcinomas. Mol Clin Oncol 1:817-819, 2013.
4. Healy AT, Otvos B, Schroeder J, Hamrahian AH, Angelov L, Kamian K: Hurthle cell carcinoma presenting as a single choroid plexus metastasis. J Clin Neurosci 21:1448-1450, 2014. 5. Heery CR, Engelhard HH, Slavin KV, Michals EA, Villano JL: Unusual CNS presentation of thyroid cancer. Clin Neurol Neurosurg 114:1107-1109, 2012. 6. Kitagawa Y, Higuchi F, Abe Y, Matsuda H, Kim P, Ueki K: Metastasis to the choroid plexus from thyroid cancer: case report. Neurol Med Chir (Tokyo) 53:832-836, 2013. 7. Manzil FF, Bender LW, Scott JW: Evaluation of rare choroid plexus metastasis from papillary thyroid carcinoma with multimodality imaging. Clin Nucl Med 39:551-553, 2014. 8. Matsumura H, Yoshimine T, Yamamoto S, Maruno M, Hayakawa T, Ono Y, Kondoh N, Namiki M: Single solitary metastasis of the slowly progressive type of renal cell carcinoma to the choroid plexus—case report. Neurol Med Chir (Tokyo) 37:916-919, 1997.
12. Wasita B, Sakamoto M, Mizushima M, Kurosaki M, Watanabe T: Choroid plexus metastasis from papillary thyroid carcinoma presenting with intraventricular hemorrhage: case report. Neurosurgery 66:e1213-e1214, 2010.
13. Zhang YA, Kavar B, Drummond KJ: Thyroid carcinoma metastasis to the choroid plexus of the lateral ventricle. J Clin Neurosci 16:118-121, 2009.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Received 29 April 2015; accepted 20 May 2015 Citation: World Neurosurg. (2015) 84, 4:1142-1146. http://dx.doi.org/10.1016/j.wneu.2015.05.027 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2015 Elsevier Inc. All rights reserved.
WORLD FEDERATION OF NEUROSURGICAL SOCIETIES Membership Services (www.wfns.org) Teresa Chen Hsiao-Hui (Teresa) Chen Office Manager, WFNS Central Office World Federation of Neurosurgical Societies 5 Rue du Marché 1260 Nyon, Vaud, Switzerland Tel: +41 (0) 22 3624303 • Fax: +41 (0) 22 3624352 Email: [email protected]
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WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2015.05.027
Bilateral Choroid Plexus Metastasis from Papillary Thyroid Carcinoma: Case Report and Review of the Literature Guive Sharifi1, Mehrdad Hosseinzadeh Bakhtevari1, Mohsen Alghasi2, Masood Asghsri Nosari1, Ramin Rahmanzade1, Omidvar Rezaei1
Key words Choroid plexus metastasis - Intraventricular tumors - Papillary thyroid carcinoma -
- BACKGROUND:
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. It has an indolent clinical course and favorable prognosis. Brain metastasis is uncommon and complicates about 0.1%e5% of PTCs. Metastasis to the choroid plexus of the lateral ventricles has been reported in 7 cases of thyroid malignancies, all of which were unilateral.
Abbreviations and Acronyms PTC: Papillary thyroid carcinoma RCC: Renal cell carcinoma
- METHODS:
From the 1Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran; and 2Department of Neurosurgery, Firuzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
- RESULTS:
To whom correspondence should be addressed: Mehrdad Hosseinzadeh Bakhtevari, M.D. [E-mail: [email protected]]
- CONCLUSIONS:
Citation: World Neurosurg. (2015) 84, 4:1142-1146. http://dx.doi.org/10.1016/j.wneu.2015.05.027 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2015 Elsevier Inc. All rights reserved.
INTRODUCTION Intraventricular tumors may arise from the ventricular wall, adjacent cerebral structures, or extracranial neoplastic lesions. The most common intraventricular neoplastic lesions include choroid plexus papilloma and meningioma. Metastases to the ventricles are infrequent, accounting for 6% of intraventricular tumors. Renal cell carcinoma (RCC) is the most reported primary carcinoma that causes intraventricular metastasis (8, 9). Most intraventricular metastases result from hematogenous dissemination of primary tumor to the choroid plexus via the anterior or posterior choroidal artery. Metastatic lesions are most commonly (>50%) located in the trigone of lateral ventricles because of the large tufts of choroid plexus in the trigone (6, 9). Choroid plexus can be the first site of metastasis for extracranial malignancies, but involvement of the choroid plexus usually accompanies metastases to other sites. To our knowledge, among 40 cases of choroid plexus metastasis reported thus far, tumor metastasized bilaterally in only 1 case of colon adenocarcinoma (11). We present a case of bilateral
1142
www.SCIENCEDIRECT.com
We report a case of a 52-year-old woman with a history of PTC who presented with severe headache, nausea and vomiting, right hemiparesis, and speech disturbance. Imaging studies depicted lesions in both lateral ventricles. The patient underwent microsurgical tumor resection. Histopathologic examination revealed choroid plexus metastasis from PTC. Metastases to the choroid plexus from extracranial tumors are very rare, with only a few cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as renal cell carcinoma, for choroid plexus, especially in the lateral ventricles. We report the eighth case of choroid plexus metastasis, but it is the first bilateral one arising from thyroid cancer.
choroid plexus metastases arising from papillary thyroid carcinoma (PTC).
MATERIALS AND METHODS Case Report A 52-year-old woman presented with a 6month history of severe headache, nausea and vomiting, and speech disturbance. Neurologic examination revealed right hemiparesis and mild speech disturbance mimicking Wernicke aphasia. She had a history of PTC of classic variant diagnosed about 3 years ago, followed by thyroidectomy and radioiodine ablation therapy. Magnetic resonance imaging (MRI) depicted a well-circumscribed mass in both lateral ventricles that homogenously enhanced after gadolinium contrast administration (Figure 1). Computed tomography angiography demonstrated the lesion’s supply from anterior and posterior choroidal arteries (Figure 2). The patient underwent craniotomy through a posterior intraparietal parasagittal approach to avoid passing the optic
radiation and to avoid the language areas covering the left trigone. Microsurgical tumor resection was performed and a left lateral ventricle tumor was excised. It was a hypervascular mass that caused a large hemorrhage during surgery (Figure 3). Because of mild intraoperative intraventricular bleeding, an external ventricular drain was placed at the time of surgery for postoperative pressure monitoring. The drain was removed on the second postoperative day when normal intracranial pressure was measured. Histopathology demonstrated choroid plexus metastasis from PTC (Figure 4). Postoperatively, the patient awoke without deficit and was discharged after 5 days in good condition. Postoperative MRI revealed total resection of the left lateral ventricle metastasis (Figure 5). The patient received radiation therapy and iodine-131 radioiodine ablation therapy for the contralateral ventricular tumor. Follow-up MRI 6 months after radioiodine therapy revealed shrinkage of the right-side metastasis, and no recurrence was detected (Figure 6).
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2015.05.027
LITERATURE REVIEW GUIVE SHARIFI ET AL.
Figure 1. Magnetic resonance imaging shows well-circumscribed mass in both lateral ventricles and a cortical mass lesion in the right hemisphere.
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
T1-weighted (A) and T2-weighted (B) images were homogeneously enhanced after gadolinium contrast administration (C and D).
DISCUSSION
Figure 2. Computed tomography angiography demonstrated the lesion’s supply from the anterior and posterior choroidal arteries.
Figure 3. Intraoperative photograph shows posterior parietal parasagittal approach. Microsurgical tumor resection was performed, and a left lateral ventricle tumor was excised.
WORLD NEUROSURGERY 84 [4]: 1142-1146, OCTOBER 2015
Tumor spread to the choroid plexus may occur through a hematogenous route via the anterior or posterior choroidal arteries or through cerebrospinal fluid seeding. Tumors most likely to metastasize to the choroid plexus are RCC and lung adenocarcinoma. Other tumors with documented spread to the choroid plexus include colon, stomach, breast, thyroid, bladder, melanoma, and lymphoma. In pediatric patients, metastases to the choroid plexus have been reported to arise from Wilms tumor, neuroblastoma, and retinoblastoma. PTC is the most common form of welldifferentiated thyroid cancer and the most common form of thyroid cancer to result from exposure to radiation. Papillary carcinoma appears as an irregular solid or cystic mass or nodule in a normal thyroid parenchyma. Papillary/follicular carcinoma is considered a variant of PTC (mixed form). Despite its well-differentiated characteristics, papillary carcinoma may be overtly or minimally invasive. These tumors may spread easily to other organs. Papillary tumors have a propensity to invade lymphatics but are less likely to invade blood vessels. The life expectancy of patients with this cancer is related to their age. The prognosis is better for younger patients than for patients who are >45 years old. Of patients with papillary cancers, about 11% present with metastases outside the neck and mediastinum. There are different types of thyroid carcinomas with different clinical courses, prognoses, and survival rates. PTC is the most common type (70%e90%). A welldifferentiated, slow-growing thyroid cancer
www.WORLDNEUROSURGERY.org
1143
LITERATURE REVIEW GUIVE SHARIFI ET AL.
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
Figure 4. Histopathology demonstrated metastasis from papillary thyroid carcinoma and showed a papillary tumor with cytomorphologic
characteristics of papillary carcinoma ground-glass nuclei (long arrow) and grooves (short arrow).
Figure 5. Postoperative magnetic resonance imaging with contrast enhancement revealed complete resection of the mass.
Figure 6. Follow-up magnetic resonance imaging 6 months after radioiodine therapy revealed shrinkage of the right-side metastasis. L, left; R, right.
1144
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WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2015.05.027
LITERATURE REVIEW
WORLD NEUROSURGERY 84 [4]: 1142-1146, OCTOBER 2015
OP: posterior parietal parasagittal approach and microsurgical tumor resection
I, iodine-131; PET, positron emission tomography. 131
PTC, papillary thyroid carcinoma; OP, operative approach; M, male; F, female; *The article is in Spanish, and we did not have access to its data. yChoroid plexus metastasis was the first presentation of thyroid carcinoma.
PTC
Both lateral ventricles 52/F Sharifi et al., 2015 (present study)
36
Incidentally detected on PET scan PTC (Hürthle cell variant)
Left trigone 70/F Healy et al., 2014 (4)
6
Severe headache, nausea and vomiting, speech disturbance
24
OP: Gamma Knife radiosurgery and surgical resection
I scan OP: Gamma Knife stereotactic radiosurgery
131
PTC
Left trigone 62/M Manzil et al., 2014 (7)
Incidentally detected on posteradioiodine therapy whole-body
Open biopsy (parietal transcortical) and radiation therapy 8 Vertigo, memory loss, clumsiness in the left hand —y Thyroid carcinoma 74/F Kitagawa et al., 2013 (6)
Right trigone
OP: parieto-occipital craniotomy and resection 2 Confusion, ataxia, dysarthria, urinary incontinence 36 PTC 88/M Heery et al., 2012 (5)
Left occipital horn
OP: occipital transcortical approach 8 Severe headache, nausea, vomiting 24 75/M Wasita et al., 2010 (12)
PTC (conventional variant)
Follicular thyroid carcinoma Right trigone and multifocal PTC (follicular variant) 62/M Zhang et al., 2009 (13)
Right trigone
OP: transcallosal subtotal excision Progressive short-term memory loss —y
12
OP: parieto-occipital craniotomy and resection Severe headache, nausea PTC (tall cell variant)
Occipital horn
24
6
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
Ferrer García et al., 2002 (2)*
Presenting Symptoms Interval (months) Location of Metastasis Histopathology of Primary Tumor Age (years)/Sex Authors, year
Table 1. Literature Review of 8 Cases of Choroid Plexus Metastasis from Thyroid Cancer
Duration (weeks)
Management
GUIVE SHARIFI ET AL.
with a benign clinical course, PTC is usually diagnosed (>80%) in early stages after a latency period of 10e20 years. It has a 10-year survival rate of 90%e95% (1). PTC usually metastasizes through the lymphatic route to cervical lymph nodes, although hematogenous spread to uncommon metastatic sites is possible, especially if treatment has been inadequate. Distant metastases at the time of diagnosis is rare. If distant metastasis is present, it mainly involves lung and bone and worsens the prognosis. Brain metastases constitute 0.1%e5% of PTCs and are associated with a median survival of 12.4 months (1). PTCs are classified into histopathologic variants based on growth patterns, cell types, and stromal changes (10). Some variants, such as tall cell variant, are more aggressive and appear to have more susceptibility to metastasis to the rare secondary sites, although less aggressive variants of PTC, such as conventional variant, also can metastasize to uncommon sites, especially if treatment was inadequate (2, 3, 10). A combination of duration of spread, biologic nature of variants, and “seed and soil” relationship between metastatic cells and the secondary site (e.g., choroid plexus) appears to play a role. For example, the higher rate of choroid plexus metastases from kidney (40%) versus lung (7.5%) with consideration of the point that brain metastases mostly arise from lung (approximately 40%e50%) versus kidney (approximately 5%e10%) demonstrates that RCCs have a higher propensity to the choroid plexus versus cerebral parenchyma compared with lung carcinoma (8). Differential diagnoses of bilateral choroid plexus tumors of lateral ventricles in the literature include choroid plexus papilloma; choroid plexus carcinoma; xanthogranuloma; and metastasis from colon, RCC, and lung adenocarcinoma. One interesting point of this case was the bilateral manifestation of metastasis, which is now in the differential diagnosis of bilateral choroid plexus tumors. There is a higher rate of choroid plexus metastases from slow-growing subtypes that have an indolent course versus aggressive ones; this is seen in thyroid carcinomas (Table 1) and RCCs and suggests the duration of spread as an important factor playing a role in choroid plexus metastases (12). Metastases from
www.WORLDNEUROSURGERY.org
1145
LITERATURE REVIEW GUIVE SHARIFI ET AL.
thyroid cancer to the choroid plexus are extremely rare; the previously reported 7 cases are summarized in Table 1. Because of the small number of reported cases of intraventricular metastases, there is no established treatment protocol. Different treatment modalities and surgical approaches are reported. In studies reporting surgical treatment, surgery is emphasized as an important part of treatment that significantly increases survival (9, 13). Nonsurgical treatments for intraventricular metastases arising from thyroid carcinomas include wholebrain radiation therapy and radioiodine therapy. A combination of surgical and nonsurgical modalities seems to result in a better survival. CONCLUSIONS Metastases to the choroid plexus from extracranial tumors are very rare, with only 40 cases reported thus far. A demographic analysis of these cases suggests there may be a tropism of some extracranial carcinomas, such as RCC, for choroid plexus. We report the eighth case of choroid plexus metastasis arising from thyroid cancer. Although it is rare, choroid plexus metastasis from PTC must be included in the list of differential diagnoses for intraventricular tumors, especially in patients with a past history of PTC.
BILATERAL CHOROID PLEXUS METASTASIS FROM PTC
REFERENCES 1. Al-Anazi A, Shannon P, Guha A: Solitary metastasis to the choroid plexus. Case illustration. J Neurosurg 92:506, 2000.
9. McWilliams RR, Giannini C, Hay ID, Atkinson JL, Stafford SL, Buckner JC: Management of brain metastases from thyroid carcinoma: a study of 16 pathologically confirmed cases over 25 years. Cancer 98:356-362, 2003.
2. Ferrer García JC, Merino Torres JF, Ponce Marco JL, Piñón Sellés F: Unusual metastasis of differentiated thyroid carcinoma [in Spanish]. An Med Interna 19:579-582, 2002.
10. Lloyd RV, Buehler D, Khanafshar E: Papillary thyroid carcinoma variants. Head Neck Pathol 5: 51-56, 2011.
3. Hassaneen W, Suki D, Salaskar AL, Wildrick DM, Lang FF, Fuller GN, Sawaya R: Surgical management of lateral-ventricle metastases: report of 29 cases in a single-institution experience. J Neurosurg 112:1046-1055, 2010.
11. Tsuda K, Tsurushima H, Takano S, Tsuboi K, Matsumura A: Brain metastasis from papillary thyroid carcinomas. Mol Clin Oncol 1:817-819, 2013.
4. Healy AT, Otvos B, Schroeder J, Hamrahian AH, Angelov L, Kamian K: Hurthle cell carcinoma presenting as a single choroid plexus metastasis. J Clin Neurosci 21:1448-1450, 2014. 5. Heery CR, Engelhard HH, Slavin KV, Michals EA, Villano JL: Unusual CNS presentation of thyroid cancer. Clin Neurol Neurosurg 114:1107-1109, 2012. 6. Kitagawa Y, Higuchi F, Abe Y, Matsuda H, Kim P, Ueki K: Metastasis to the choroid plexus from thyroid cancer: case report. Neurol Med Chir (Tokyo) 53:832-836, 2013. 7. Manzil FF, Bender LW, Scott JW: Evaluation of rare choroid plexus metastasis from papillary thyroid carcinoma with multimodality imaging. Clin Nucl Med 39:551-553, 2014. 8. Matsumura H, Yoshimine T, Yamamoto S, Maruno M, Hayakawa T, Ono Y, Kondoh N, Namiki M: Single solitary metastasis of the slowly progressive type of renal cell carcinoma to the choroid plexus—case report. Neurol Med Chir (Tokyo) 37:916-919, 1997.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Received 29 April 2015; accepted 20 May 2015 Citation: World Neurosurg. (2015) 84, 4:1142-1146. http://dx.doi.org/10.1016/j.wneu.2015.05.027 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2015 Elsevier Inc. All rights reserved.
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