Fungating thyroid cancer: a complex clinical scenario

Area of Science:

• Oncology
• Head and Neck Surgery
• Endocrine Surgery

Background:

• Locally advanced thyroid cancers can present with malignant skin infiltration, a condition termed fungating thyroid cancer (fTC).
• Research on advanced thyroid cancer management typically emphasizes aerodigestive or vascular involvement, with less focus on skin infiltration.

Purpose of the Study:

• To investigate the clinical presentation, management, and outcomes of patients with fungating thyroid cancer (fTC).

Main Methods:

• Prospective data collection of clinical, laboratory, imaging, and pathological information from head and neck and endocrine surgery patients (April 2005-March 2011).
• Analysis of eleven patients diagnosed with fTC, including their prior treatments and surgical interventions.

Main Results:

• Eleven patients presented with fTC; eight had prior surgery for undiagnosed differentiated thyroid cancer (DTC).
• Pathological diagnoses included DTC (n=3), poorly differentiated (n=5), anaplastic (n=2), and medullary thyroid cancer (n=1).
• Extensive resections and flap reconstructions were performed; complete tumor clearance (R0) was achieved in only one patient, with residual disease in others (R1/R2). Three non-operated patients died within one month; follow-up for operated patients was limited (3-6 months).

Conclusions:

• Fungating thyroid cancer (fTC) presents a significant management challenge with poor outcomes.
• Surgical intervention for fTC may offer limited survival benefit, and complete tumor clearance is difficult to achieve.
• Further research with extended follow-up is needed to ascertain the long-term survival and optimal management strategies for fTC.