Kannan, Subramanian6, Nandini, Hamsa1, Kothandaraman, Srikamakshi1, Aggarwal, Sagar1, Pillai, Vijay2, Raju, Nalini3, Coca, Pragnya4, Jain, Sandeep5, Kuriakose, Moni Abraham2, Chandrasekhar, Naveen Hedne2, Shetty, Vivek2
1 Fellow, Department of Head and Neck Surgical Oncology, Narayana Health City, Bangalore, India
2 Consultant, Department of Head and Neck Surgical Oncology, Narayana Health City, Bangalore, India
3 Consultant, Department of Pathology, Narayana Health City, Bangalore, India
4 Consultant, Department of Medical Oncology, Narayana Health City, Bangalore, India
5 Consultant, Department of Radiation Oncology, Narayana Health City, Bangalore, India
6 Consultant, Department of Endocrinology, Narayana Health City, Bangalore, India
Background: Anaplastic and poorly differentiated thyroid cancers are considered to have a very poor prognosis with survival rates less than 12 months.
Case report: A 78 year old gentleman presented with a swelling in the neck of 1 month duration with progressively worsening dysphagia and hoarseness. He gave history of right hemithyroidectomy a year ago for multinodular-goitre. CECT scan showed a 4.5 x 8 x 8cm heterogeneously enhancing soft tissue lesion arising from the left thyroid lobe and infiltrating posteriorly into laryngo-tracheal area, hypopharynx and upper esophagus upto the level of T1 vertebra with areas of necrosis and cystic changes. There were multiple heterogeneously enhancing right cervical nodes. FNAC from the left thyroid and right cervical node were similar with smears being variably cellular composed of spindled to epithelioid cells with moderate to severe nuclear pleomorphism present in a necrotic and inflammatory background. The neoplastic cells show dense orangeophilic cytoplasm and smudgy nuclei suggestive of squamous differentiation. The tumor cells are positive for pan-cytokeratin AE1/AE3 and negative for TTF-1, by immunohistochemistry suggestive of an undifferentiated (anaplastic) thyroid carcinoma. After tracheostomy and feeding jejunostomy patient received palliative intent external beam radiotherapy (40Gy/16#) with 4 cycles of Adriamycin. The feeding tube was removed at 3months and tracheostomy tube at 5months after treatment. A scan at this time showed interval reduction in the upper left paraesophageal lesion. A PET-CT done one year post-treatment showed no hypermetabolic lesion.
Results: At follow up 16 months post treatment, the patient is clinically doing well and considered disease free.