30yo female presented to neurosurgical clinic with a right parietal swelling associated with headache of 1 year duration. She has a past Hx of thyroidectomy 2008 but there was no reports as regards the nature of the surgery or the histopathology of the excised specimen, Her lab. work CBC, U/E, LFT, TFT were within normal. CT scan showed a malignant mass of the right parietal bone with breaking down of both inner and outer table, MRI showed RT parietal extracerebral lesion 5x6x5 cm extending through the diploic bone with a large soft tissue component. FNAC was suggestive of meningioma. The mass was then excised and the H/P result revealed an osteolytic lesion consistent with metastatic follicular lesion of the thyroid Later U/S of the thyroid showed an enlarged Lt thyroid lobe with remnants of thyroid tissue on the Rt side but no focal lesions could be demonstrated.
The questions which arise now, did the patient initially had a follicular lesion of the thyroid which was excised in 2008 and this skull lesion is some form of latent metastasis as that which can happen in breast Ca (although it was never mentioned), or is it a metastatic lesion from an existing follicular Ca despite the fact that U/S failed to demonstrate any focal lesions in the thyroid.
The second question, what are further measures that can be undertaken in such case e.g. completion thyroidectomy + RAI scan followed by RAI ablation of any metastasis.