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Curative surgery for anaplastic thyroid carcinoma: A case report
Smp Vithana1, Ead Udayakumara1, Mdp Gunasena1
1Department of Surgery, National Hospital Kandy, Kandy, Sri Lanka.
SAGE Open Medical Case Reports
|April 22, 2022
Summary
Anaplastic thyroid carcinoma, a rare and aggressive cancer, was diagnosed in a patient with a goitre. Surgical resection followed by adjuvant therapy was performed, highlighting a multimodal approach for advanced disease.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Anaplastic thyroid carcinoma (ATC) is a rare (3-4% of thyroid malignancies) but aggressive endocrine neoplasm.
- It presents with a poor prognosis, often diagnosed at advanced stages with a median survival of 6 months.
Observation:
- A 67-year-old female presented with compressive symptoms and hypothyroidism due to a hard goitre.
- Ultrasound and CT scans indicated a suspicious Thyroid Imaging Reporting and Data System 5 lesion with lymphadenopathy and possible carotid sheath involvement.
- Fine needle aspiration cytology confirmed anaplastic carcinoma.
Findings:
- Histopathology revealed anaplastic carcinoma with concurrent papillary carcinoma deposits in lymph nodes.
- The patient underwent total thyroidectomy with bilateral selective lymphadenectomy, with no intra-operative evidence of aero-digestive tract or carotid sheath invasion.
- The findings suggest anaplasia arising in a background of differentiated thyroid carcinoma.
Implications:
- The presence of both anaplastic and papillary carcinoma influences post-operative management, including thyroxine suppression and radioiodine therapy.
- Multimodal treatment, including curative surgery and adjuvant therapies, is crucial for advanced ATC.
- Complete tumor resection (R0/R1) is the surgical goal for locally advanced disease, potentially after down-staging.
