Kumar Vijay, Blanchon Bruno, Gu Xin, Fowler Marjorie, Scarborough David, Nathan Cherie Ann, Yaturu Subhashini
Section of Endocrinology, VAMC/LSUHSC, Shreveport, LA 71101-4295, USA.
Endocr Pathol. 2005 Fall;16(3):245-50. doi: 10.1385/ep:16:3:245.
We report a rare case of thyrotoxicosis in a patient with anaplastic thyroid cancer. A 65-yr-old male presented with a 2-d history of rapidly enlarging neck mass and back pain. Physical examination revealed a large, hard thyroid mass and resting tachycardia. He did not have any symptoms suggestive of airway compression at presentation. Thyroid hormone levels were consistent with a hyperthyroid state. CT scan of the neck and thorax showed a heterogeneous mass replacing the thyroid, bilateral pulmonary nodules, and a metastasis with pathological fracture at the level of T-8. Technetium-pertechnetate scan failed to show any uptake in the region of the thyroid. Fine needle aspiration of the thyroid revealed anaplastic thyroid cancer. The patient was started on steroids and radiation therapy of his spine lesion. Brief surgical exploration of the thyroid revealed extensive local infiltration of adjacent neck tissues and marked tumor necrosis. Immunohistochemical stains of the tumor were positive for p53, thyroglobulin, and thyroid transcription factor-1. The tumor had an extremely aggressive course and the patient died of asphyxiation from severe airway compromise 11 d after his initial presentation.
我们报告了一例未分化甲状腺癌患者发生甲状腺毒症的罕见病例。一名65岁男性，有颈部肿块迅速增大和背痛2天的病史。体格检查发现甲状腺有一个大的硬块，静息时心动过速。就诊时他没有任何提示气道受压的症状。甲状腺激素水平与甲状腺功能亢进状态一致。颈部和胸部CT扫描显示一个不均匀的肿块取代了甲状腺，双侧肺结节，以及T-8水平的病理性骨折转移灶。高锝酸盐扫描未显示甲状腺区域有任何摄取。甲状腺细针穿刺显示为未分化甲状腺癌。患者开始接受类固醇治疗和脊柱病变的放射治疗。对甲状腺进行的简短手术探查显示颈部相邻组织广泛局部浸润和明显的肿瘤坏死。肿瘤的免疫组织化学染色p53、甲状腺球蛋白和甲状腺转录因子-1呈阳性。肿瘤病程极具侵袭性，患者在初次就诊11天后死于严重气道受压导致的窒息。
