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we report a case of a 41-year old man presented with a solid mass located in the left temporo - occipital region . the 3d computed tomography showed a large solid mass with high vascularity , skull erosion and supra - infratentorial epidural mass effect .
the patient underwent surgery where a soft mass with transverse sinus invasion was encountered ; the tumour was successfully resected employing microsurgical techniques .
histological examination revealed a thyroid follicular neoplasm with positive staining for follicular carcinoma in immunohistochemical analysis .
treatment was planned for the thyroid gland , patient receiving 6 courses of chemotherapy including paclitaxel .
the present case emphasizes that although they are uncommon , dural metastasis can be mistaken for meningiomas . the definitive diagnosis of a meningioma should be established only after the histopathological analysis .
thyroid follicular carcinoma should be included in the differential diagnosis in cases of extrinsic tumoral lesions .
metastasis in the skull associated with carcinoma of the thyroid accounts for only 2.55.8% of cases , but the initial presentation with distant metastasis is uncommon .
isolated forms have radiological features that strongly suggest a primary tumor , and furthermore , their macroscopic appearance during surgery may even be taken for a meningioma . in this paper
, we described a patient who initially presented a tumor that invaded the scalp , dura mater , transverse sinus , supra and infratentorial space , mimicking a malignant meningioma .
a 41-year - old man was referred to our institute with a 1-year history of persistent headache and a mass in the left temporo - occipital region , the mass had developed in the last year and rapidly grown within 6 months .
the computed angiotomography showed a large extrinsic solid lesion with epidural mass effect and contrast enhancement causing bone destruction .
mri showed a supra - infratentorial tumour location with invasion of the scalp and left transverse dural sinus ( fig .
1 ) . mri showing an extrinsic mass with scalp , bone and dura involvement .
the mass causes bone erosion and has supra - infratentorial , and left transverse sinus extension .
intraoperatively , the tumour was found immediately in the scalp appearing as a soft , reddish , highly vascularizated mass with dural invasion .
the inferior and posterior borders of the tumour encased the left transverse sinus ; the tumour was successfully dissected employing microsurgical techniques .
histological examination revealed a thyroid differentiated neoplasm with positive staining for thyroglobulin and follicular carcinoma in immunohistochemical analysis ( fig .
a tissue removed from the tumour zone showing cubic cells resembling thyroid follicular cells ( hemotoxylin and eosin , original magnification 9400 ) .
the incidence of thyroid carcinoma is about 1 per 25,000 populations , accounts for approximately 1% of all thyroid tumours .
the mean age of presentation in a case series of 12 patients reported was 60 years and a female preponderance was seen .
batson demonstrated a vertebral venous plexus which consisted of a valveless vascular bed within the spinal canal and extended from the skull to the pelvis .
batson and eckenhoff showed that there were multiple anastomosis and free connections between this venous plexus and the dural sinuses .
more recently arterial spread has also been suggested because of the association with secondary cutaneous locations in the territory of ipsilateral external carotid artery .
patients usually have a long clinical course before the diagnosis of skull lesion , and the principal clinical features are a palpable scalp tumour , disturbance of consciousness , hemiparesis , headache , cranial nerve dysfunction and exophthalmos have all been reported . in our case , the period until diagnosis of the definite metastatic focus was 1 year .
eighty percent of patients with thyroid follicular carcinoma are seen initially with a solitary thyroid nodule .
nevertheless , there are very few reports regarding the initial presentation of patients with distant metastasis leading to diagnosis of follicular carcinoma[1320 ] .
reported a rare initial manifestation of a giant mass on the right scapula of a female patient .
the diagnosis in our case was difficult , because based on neuroimaging findings the most likely diagnosis was malignant meningioma .
anatomically , skull metastatic lesions are most frequently located over the occipital region , isolated papers report sellar region , posterior fossa , skull base[1416 ] .
skull metastatic lesions were found to be osteolytic on ct scan , and highly vascular on angiographic assessment , the same as occurred in our case .
the differential diagnosis of sarcoma and metastasis should always be considered when a lytic skull lesion with irregular edges and absence of peripheral sclerosis is identified , even in the young patient .
the primary focus of thyroid metastasis , which causes large bone defects , is difficult to define , metastatic tumours with unidentified primary tumour histology have been reported in patients with normal thyroid glands .
the best treatment for skull metastasis remain to be determined , but the current literature supports the excision of the lesion of the skull , removal of the thyroid tissue and maintenance tsh - suppression .
radiotherapy and iodine internal radiation are other treatment options recommended for highly vascularised metastatic skull tumours .
only 17% of metastatic lesions to the brain take up iodine , so the effect of radioactive ablation on brain metastasis is very restricted .
intracranial metastasis have been treated by external beam radiation or radioactive ablation using iodine but the effect was very limited .
the primary tumor is treated with radioactive iodine . in the absence of established treatment protocols to follow up in patients with intracranial metastasis from follicular carcinoma ,
this is a rare case of follicular thyroid carcinoma metastasized to the bone with supra - infratentorial extension .
context : follicular thyroid cancer rarely manifests itself as a distant metastatic lesion.case report : we report a case of a 41-year old man presented with a solid mass located in the left temporo - occipital region . 
 the 3d computed tomography showed a large solid mass with high vascularity , skull erosion and supra - infratentorial epidural mass effect . 
 after magnetic resonance imaging ( mri ) a suspect diagnosis of meningioma was made . 
 the patient underwent surgery where a soft mass with transverse sinus invasion was encountered ; the tumour was successfully resected employing microsurgical techniques . 
 histological examination revealed a thyroid follicular neoplasm with positive staining for follicular carcinoma in immunohistochemical analysis . 
 postoperatively levels of thyroid hormones were normal . 
 treatment was planned for the thyroid gland , patient receiving 6 courses of chemotherapy including paclitaxel.conclusions:the present case emphasizes that although they are uncommon , dural metastasis can be mistaken for meningiomas . 
 the definitive diagnosis of a meningioma should be established only after the histopathological analysis . 
 thyroid follicular carcinoma should be included in the differential diagnosis in cases of extrinsic tumoral lesions .