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Hürthle cell follicular carcinoma of the thyroid gland presenting with diffuse meningeal carcinomatosis and evolving to anaplastic carcinoma
  1. Carlo Maria Stucchi1,
  2. Valentina Vaccaro2,
  3. Anna Magherini3,
  4. Carmela Di Gregorio4,
  5. Gabriele Greco5,
  6. Virginia A Livolsi6,
  7. Giampaolo Papi7
  1. 1Department of Neurology
  2. 2Department of Internal Medicine, Azienda USL Modena, Italy
  3. 3Department of Neurology, Ospedale S.Agostino-Estense, Modena, Italy
  4. 4Section of Pathology, Azienda USL Modena, Italy
  5. 5Department of Neurology
  6. 6Department of Pathology, University of Pennsylvania, Philadelphia, USA
  7. 7Department of Internal Medicine, Azienda USL Modena, Italy
  1. Correspondence to:
 Dr Giampaolo Papi
 MD, Dipartimento di Medicina Interna, Ospedale “Ramazzini”, Via S. Giacomo, 2, 41012 Carpi (MO), Italy; papigiampaolo{at}hotmail.com

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Hürthle cell follicular carcinoma (HCFC) of the thyroid gland is a malignant tumour composed predominantly or entirely of oncocytes (also called “Hürthle” or “Askenazy” cells),1 arranged in a follicular/trabecular pattern without the cytological changes found in papillary carcinoma.1,2 Although most studies have demonstrated that HCFC and follicular thyroid carcinoma share similar clinical behaviour and prognosis,3 recently the World Health Organization (WHO) has classified HCFC as a separate and distinct entity.4 Anaplastic thyroid carcinoma accounts for 5–10% of all thyroid cancers and represents the most aggressive thyroid tumour almost invariably associated with a fatal outcome.5 Most anaplastic thyroid carcinoma cases show evidence of a pre-existing differentiated, or poorly differentiated, thyroid carcinoma.2,5 At present, to our knowledge, the secondary leptomeningeal localisation of thyroid HCFC has not yet been reported in the literature.

CASE REPORT

We describe the case of a 56-year-old woman who was admitted to the hospital due to a 3-day history of partial seizures, unsteady walk with frequent falls and dysarthria. She had no history of either neck irradiation or thyroid diseases in her family. Fifteen years before, laboratory and imaging investigations disclosed a euthyroid goitre with a 15 mm hypoechoic, scintigrafically “cold”, nodule in the left thyroid lobe. She was not submitted to fine-needle aspiration biopsy, …

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