Surgical management of metastatic Hürthle cell carcinoma to the skull base, cortex, and spine: illustrative case

Abstract

Background: Hürthle cell carcinoma (HCC) is an unusual and aggressive variant of the follicular type of differentiated thyroid cancer (DTC), accounting for less than 3% of DTCs but posing the highest risk of metastasis. Brain metastases are uncommonly reported in the literature but pose a poor prognosis. The low rate of brain metastases from HCC coupled with ambiguous treatment protocols for the extracranial disease complicate successful disease management and definitive treatment strategy. The authors present the case of a patient with HCC metastasis to the skull base, cortex, and spine with recent tibial metastasis.

Observations: Despite the presence of metastasis to the cortex, skull base, and spine, the patient responded very well to radiation therapy, sellar mass resection, and cervical spine decompression and fixation and has made a remarkable recovery.

Lessons: The authors' multidisciplinary approach to the patient's care, including a diverse team of specialists from oncology, neurosurgery, orthopedic surgery, radiology, endocrinology, and collaboration with clinical trial researchers, was fundamental to her successful outcome, demonstrating the utility of intersecting specialties in successful outcomes in neuro-oncological patient care.

Keywords: metastatic Hürthle cell carcinoma; multidisciplinary management; neurosurgery.

FIG. 1

Preoperative imaging. A–C: Left frontal calvaria lesion (red circles, 28 × 24 mm) consistent with an osseous metastasis, demonstrating clear deep extension into the left frontal extra-axial space and superficial extension into the left frontal scalp. Mild mass effect on the adjacent left frontal lobe also appears. D–F: Enhancing sellar/suprasellar mass (red circles, 19 × 16 × 23 mm) showing considerable suprasellar extension with secondary superior displacement of the adjacent optic chiasm and posterior aspects of both optic nerves. No definite cavernous sinus invasion can be detected. G–I: Mass involving the posterior elements at the C7, T3, and C4 levels. At C6–7, there is bulging of the posterior elements of C6 and C7 with a large metastasis resulting in severe compromise of the cord and signal change in the cord suggestive of myelomalacia at the C6–7 level, particularly at C7. Compromise at T1–2 can also be noted. CT = computed tomography; MRI = magnetic resonance imaging.

FIG. 2

Postoperative imaging. A–C: Postsurgical changes from an endonasal resection of the sellar/suprasellar mass. The bulk of the tumor has been removed along the sellar component. Mild residual tumor along the suprasellar component abutting the optic chiasm with associated mild deviation of the optic chiasm superiorly can be seen. D–F: Status postcervical spinal fusion. No new lesions are noted, and no enhancing masses are identified.