Efficacy of anlotinib combined with radioiodine to treat scalp metastasis of papillary thyroid cancer: A case report and review of literature

Figure 1 A scheme of the diagnoses and treatments in chronological order. PTC: Papillary thyroid cancer; PET-CT: Positron emission tomography-computed tomography.

Figure 2 Histological and computed tomography images of the skull tumor. A: positron emission tomography-computed tomography (PET-CT) imaging of the thyroid performed on initial diagnosis of the patient (November 16, 2020); B: Pathology of scalp mass biopsy (November 3, 2020). Scalp tumor histology similar to papillary thyroid carcinoma; papillary thyroid carcinoma metastasis was considered; C: PET-CT imaging of scalp metastasis (November 16, 2020). Note the hypermetabolic mass in the left temporoparietal bone, thinning of the corresponding temporoparietal bone due to compression, and local disappearance of the cerebral sulcus on the left side; D: Postoperative thyroid nodule pathology (paraffin) (March 18, 2021). Papillary thyroid carcinoma, classical type, interstitial fibrosis, no nerve infiltration or blood vessel invasion were observed. The tumor involved extra-glandular fibrofatty tissue.

Figure 3 Computed tomography image and color ultrasound of the skull throughout the treatment course and of the thyroid gland. A-C: Computed tomography images at admission (November 4, 2020; A), at the start of anlotinib treatment (January 19, 2021; B), and during maintenance medication (April 30, 2021; C); D: Color ultrasound images of a thyroid nodule with calcification (January 19, 2021); E: Preoperative color ultrasonography showed that the thyroid tumor size was significantly reduced after neoadjuvant anlotinib therapy (March 15, 2021).

Figure 4 Scheme of tyrosine kinase inhibitor activity. In order to activate signal transduction cascades, tyrosine kinase receptors must be phosphorylated by a tyrosine kinase in addition to binding with their specific ligands. Tyrosine kinase inhibitors block the activity of tyrosine kinases via different mechanisms. TKI: Tyrosine kinase inhibitor; P: Phosphate; PI3L/Akt: Phosphatidylinositol-3-kinase/Akt; MAPK: Mitogen-activated protein kinase; JAK/STAT: Janus kinase/signal transducer and activator of transcription.