Eve E. Moscato, H. Jane Kim, M. Reza Vagefi and Rona Z. Silkiss
A 60-year-old woman with a history of follicular thyroid carcinoma with insular component presented with a large asymptomatic sphenoid wing mass discovered on routine surveillance. Therapeutic options including observation, surgical excision, radiation therapy, and I-131 therapy were initially debated. Each option presented potential morbidity. The patient initially underwent treatment with iodine-131 (I-131) with a decrease in size of the mass over 8 months. Subsequent MRI at 11 months revealed enlargement of the sphenoid wing mass with involvement of the orbital apex, cavernous sinus, and the middle cranial fossa. The patient ultimately underwent surgical resection and debulking via a frontotemporal orbitozygomatic approach. Although rare, follicular thyroid carcinoma with insular features often has an aggressive clinical course with local invasion and distant metastases. It carries a poor prognosis and can be difficult to treat due to a lack of available treatment protocols and the known morbidity of current therapies.