A 76-year old female patient had the initial diagnosis of FTC 18 years ago. She had total thyroidectomy with bilateral neck dissection and multiple reoperations for recurrent tumor. Because of an irresectable local recurrence with tracheal infiltration a tracheotomy was performed two years ago. Five sets of internal radiation therapy, had been performed one year ago with a cumulative activity of 55.400 MBq131I. She was admitted to our hospital because of four intensively vascularized scalp tumors, two of them of hen's egg size (Fig. , and ) which showed recurrent episodes of contact bleeding during hair dressing. Computed tomography revealed multiple pulmonary, hepatic and bone metastases. Thyreoglobulin level was highly elevated (6750 ng/ml) Nevertheless the patient was in a good general condition. We performed a resection of the scalp tumors under general anesthesia. Histopathology confirmed cutaneous metastases of FTC (Fig. ). The places of resection were primary left for granulation. After achievement of a clean granulation area using vacuum therapy (V.A.C.®, KCI International, Amsterdam, The Netherlands) we performed a mesh graft skin transplant (Fig. ).
a) and b) Two scalp tumors at admission of the patient, lateral view.
Giant parietal scalp tumor and to additional smaller tumors, intraoperative view.
Operative specimen, Haematoxylin-Eosin and Thyreoglobulin staining.
Mesh Graft transplants. a) Retroauricular mesh graft transplant; b) Parietal mesh graft transplant.
A follow up examination fourteen months later showed a very good cosmetic result with nearly complete healing of the mesh graft transplant (Fig. ). Because the local neck tumor had continued to grow the patient was now convinced to accept external radiation therapy and was admitted to our department of radiation oncology.
14 months follow up. a) view from on high; b) lateral view.