a painful cranial bulge
TRANSCRIPT
www.thelancet.com Vol 377 May 21, 2011 1777
Clinical Picture
Lancet 2011; 377: 1777
Published OnlineApril 8, 2011DOI:10.1016/S0140-6736(10)61089-6
This online publication has been corrected. The corrected version fi rst appeared at thelancet.com on May 20, 2011
Centre for Research on Angiogenesis Inhibitors (CERIA), Department of Medical Oncology (R Coriat MD, O Mir MD, S Ropert MD, F Goldwasser PhD), Department of Nuclear Medicine (J Clerc PhD) Hôpital Cochin, Université Paris Descartes, France
Correspondence to:Dr Romain Coriat MD MSc, Centre for Research on Angiogenesis Inhibitors (CERIA), Department of Medical Oncology, Cochin teaching Hospital, Université Paris Descartes, [email protected]
A painful cranial bulgeRomain Coriat, Olivier Mir, Stanislas Ropert, Jerôme Clerc, François Goldwasser
A 56-year-old woman with radio-iodine resistant follicular thyroid carcinoma presented to us with progressive metastatic disease in her lungs, brain, and skull . She had no symptoms apart from a painful cranial bulge. A CT of her head showed a scalp mass with osteolysis of her skull. The parietal, occipital, and temporal bones were aff ected (fi gure A and B). Her thyroglobulin serum concentration was 102 300 μg/L (normal range <55 μg/L). We treated our patient with the tyrosine protein kinase inhibitor, Sorafenib, at a fi xed dose of 400 mg twice daily. She tolerated the treatment well, and after 2 months her cranial bulge was reduced to a painless, softened mass with necrotic areas (fi gure C). Her thyroglobulin serum concentration had decreased to 47 500 μg/L. Further imaging showed a partial response in both her brain and pulmonary metastases. Our patient had a sustained response to sorafenib for 24 months. Sorafenib is not yet licensed for the treatment of thyroid cancer. A phase II trial (NCT00654238) investigating this drug for thyroid cancer is recruiting patients.
Figure: CT of the head showing metastatic follicular thyroid cancer(A) CT of scalp mass showing osteolysis of the cranial vault; (B) bone windowing showing invasion of the tumour into the bone; and (C) showing necrosis of the scalp mass (arrows) after sorafenib therapy.
A
C
B