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Year : 2010  |  Volume : 47  |  Issue : 2  |  Page : 228-229

Temporal bone metastasis from thyroid

1 Department of ENT and Head, Neck Surgery, MAM College and Assoc., LN Hospital, New Delhi, India
2 Department of Pathology, MAM College and Assoc., LN Hospital, New Delhi, India

Date of Web Publication5-May-2010

Correspondence Address:
A Sayal
Department of ENT and Head, Neck Surgery, MAM College and Assoc., LN Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.63012

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How to cite this article:
Raj A, Sayal A, Meher R, Girhotra M, Jain S. Temporal bone metastasis from thyroid. Indian J Cancer 2010;47:228-9

How to cite this URL:
Raj A, Sayal A, Meher R, Girhotra M, Jain S. Temporal bone metastasis from thyroid. Indian J Cancer [serial online] 2010 [cited 2021 Oct 27];47:228-9. Available from: https://www.indianjcancer.com/text.asp?2010/47/2/228/63012


Carcinoma metastasizing to the temporal bone is a rare entity. Most common secondary metastasis occurs from the breast (21.3%) followed by lung (12.8%), prostate (10.5%), skin (8.5%), cervix (6.4%), liver (6.4%), brain (4.3%), and oral cavity (2.1%). [1] Thyroid carcinoma metastasizing to the temporal bone is still rare. Very few case reports of thyroid carcinoma metastasizing to the temporal bone have been reported in the past. Review of literature reveals that in most case reports, the histological types have not been mentioned. [2] We describe here a case of a 60-year-old female, who presented with complaints of decreased hearing in the left ear, tinnitus for three months, recurrent multiple episodes of bleeding from the left ear, deviation of face for the past 13 days, and earache for 10 days, but no history of any ear discharge, vertigo, vomiting, seizures or loss of consciousness. Examination of the left ear revealed a diffuse, nontender, postaural swelling, a fleshy polypoidal mass in the external auditory canal and left Lower Motor Neuron facial palsy. Systemic examination revealed a 5 Χ 6 cm, hard, globular, neck swelling that moved with deglutition. According to the patient, this painless swelling had been there for the past 25 years, although she had noticed an increase in size during the past four months. Investigations (pure tone audiometry) revealed a conductive type of hearing loss and a polyp arising from the middle ear cavity on aural examination, under a microscope. Biopsy of the polypoidal mass and fine needle aspiration cytology (FNAC) from the postaural region revealed metastatic follicular carcinoma [Figure 1]. On Contrast Enhanced Computed Tomography (CECT) of the temporal bone and neck, an intensely and homogenously enhancing lesion involving the left temporal bone with intracranial extension was noted [Figure 2] and[Figure 3]. The left lobe of the thyroid was found to be bulky, with a multifollicular appearance, without infiltration of the surrounding structures [Figure 4]. Chest X-ray, ultrasound of the abdomen, and whole body scan did not reveal distant metastasis. The patient refused to undergo any surgical intervention and was therefore referred for radiotherapy.

The most common site for involvement in metastasis to temporal bone is the petrous apex, probably owing to the sluggish blood supply at the petrous apex, followed by the tegmen tympani. [3],[4]

Patients with temporal bone metastasis may remain asymptomatic or present with a variety of complaints, such as, sudden hearing loss, dizziness, tinnitus, facial palsy, otalgia, swelling behind the ear, bleeding from the ear, and even features of increased intracranial tension. Any patient presenting with facial palsy, sudden sensory neural hearing loss, and periauricular swelling should raise suspicion of a metastatic temporal bone tumor. [5] Such patients should undergo a detailed neurotological examination, pure tone audiometry, Brainstem Evoked Response Audiometry, and CECT of the temporal bone, brain, and the region of the primary. [6] Histological diagnosis should be established by a biopsy, FNAC or immunohistochemical analysis of the surgical specimen. Treatment for such cases usually consists of total thyroidectomy for the primary tumor and additional radioactive iodine therapy for any remaining metastatic thyroid tissue that is able to take up iodine. Caution should be exercised if imaging studies show metastatic thyroid tissue in the brain, because radioactive iodine therapy may cause tissue necrosis and brain swelling with intracranial hypertension and possible death. [7],[8]

This case report adds to the growing list of rare yet possible metastasis to the temporal bone from a distant primary, and highlights the need for alertness of the treating physician when dealing with such cases.

  References Top

1.Gloria-Cruz TI, Schachern PA, Paparella MM, Adams GL, Fulton SE. Metastasis to temporal bones from primary nonsystemic malignantneoplasms. Arch Otolaryngol Head Neck Surg 2000;126:209-14.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Redleaf MI, Bauman NM, Robinson RA, Gantz BJ. Medullary carcinoma of the thyroid metastatic to the temporal bone. J Laryngol Otol 1995;109:1200-3.  Back to cited text no. 2  [PUBMED]    
3.Berlinger NT, Koutroupas S, Adams G, Maisel R. Patterns of involvement of the temporal bone in the metastatic and systemic malignancy. Laryngoscope 1980;90:619-27.  Back to cited text no. 3  [PUBMED]    
4.Fukaya H, Suzuki C, Yasuta H, Ohtani I. Temporal bone findings in multiple endocrine neoplasia type 2B. Eur Arch Otolaryngol 2000;257:273-5.  Back to cited text no. 4      
5.Maddox HE 3rd. Metastatic tumours of the temporal bone. Ann Otol Rhinol Laryngol 1967;76:149-65.  Back to cited text no. 5  [PUBMED]    
6.Hindersin S, Schubert O, Cohen M, Felsberg J, Schipper J, Hoffmann TK. Angiosarcoma of the temporal bone. Larygorhinootologie 2008;87:345-8.  Back to cited text no. 6      
7.John C. Watkinson, Mark N. Gaze, Janet A. Wilson. Tumours of the thyroid and parathyroid gland: Stell and Maran, Head and neck surgery. 4th ed: Butterworth- Heinemann; 2000. p. 469-78.  Back to cited text no. 7      
8.Moore MG, Deschler DG, McKenna MJ, Varvares MA, Lin DT. Management outcomes following lateral temporal bone resection for ear and temporal bone malignancies. Otolaryngol Head Neck Surg 2007;137:893-8.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
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Mohamad, I. and Hashim, H.Z. and Othman, N.A.N.
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