[A case of calvarial metastasis of thyroid carcinoma with intraorbital extension]

A 63-year-old man came to our hospital with complaints of exophthalmos and a tumor in the right temporal region. Physical examination revealed not only these findings but also a tumor in the right lateral side of the neck. Plain skull X-ray showed radiolucent area with irregular non-sclerotic margin in the right temporal region of the skull and erosion of the lateral half of the right minor sphenoid wing. Post-contrast CT demonstrated a homogeneously enhanced tumor in the right temporal region with extracranial and intracranial extension, partly invading the right orbita, which compressed the eyeball anterioinferiorly. On MRI (TR 500msec, TE 30msec), the tumor showed an isointensity area with a thin rim of low intensity. Right external carotid angiography revealed the numerous tumor vessels fed by the middle meningeal artery, the accessory meningeal artery and the anterior branch of the superficial temporal artery. On right internal carotid angiography, it was shown that the branches of the right ophthalmic artery were also feeding the tumor. 99Tc scintigraphy demonstrated the areas of increased radionuclide concentration in the skull and neck lesion. Preoperative embolization of the tumor vessels fed by the external carotid artery system was performed. Chopped gelfoam serving as embolization material were injected through a transfemoral catheter, selectively placed into the external carotid artery. Following this procedure, the numerous tumor vessels disappeared completely.