Xing Jeffrey C, Bishop Justin A, Mathioudakis Nestoras, Agrawal Nishant, Tufano Ralph P
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0910, USA.
Case Rep Med. 2011;2011:583978. doi: 10.1155/2011/583978. Epub 2011 Sep 7.
Anaplastic thyroid cancer (ATC) is rare but extremely aggressive, which accounts for about 2% of all thyroid cancers yet nearly 50% of thyroid-cancer-associated deaths in the United States. The median survival time from diagnosis is 5 months, with a 1-year survival rate of only 20%. We report here a case of ATC in a 56-year-old man who survived a large ATC. Preoperative fine-needle aspiration biopsy study to a large right thyroid mass suggested ATC. Total thyroidectomy with radical lateral neck and central neck dissection removed a well-circumscribed 9.5 cm tumor without extrathyroidal extension or lymphovascular invasion. All 73 lymph nodes removed were negative for metastasis. The tumor consisted of highly pleomorphic, undifferentiated cells with large zones of necrosis and loss of thyroid transcription factor-1 and thyroglobulin expression. A focal well-differentiated component and PAX8 expression confirmed its thyroid follicular cell origin. Nine months after postsurgical adjuvant concurrent radiation therapy and chemotherapy, the patient remained well without clinical, biochemical, and radiographical evidence for cancer recurrence. This is an unusual case of ATC in that it is one of the largest ATC tumors reported to display mild pathologic behavior and relatively long-term patient survival.
间变性甲状腺癌（ATC）罕见但极具侵袭性，约占美国所有甲状腺癌的2%，却导致近50%的甲状腺癌相关死亡。诊断后的中位生存时间为5个月，1年生存率仅为20%。我们在此报告一例56岁男性间变性甲状腺癌患者，该患者在患有巨大间变性甲状腺癌的情况下存活下来。对右侧甲状腺大肿块进行术前细针穿刺活检检查提示为间变性甲状腺癌。行全甲状腺切除术并进行根治性侧颈和中央颈清扫，切除了一个边界清楚的9.5厘米肿瘤，无甲状腺外侵犯或脉管侵犯。切除的73枚淋巴结均无转移。肿瘤由高度多形性、未分化细胞组成，有大片坏死区域，甲状腺转录因子-1和甲状腺球蛋白表达缺失。局灶性高分化成分和PAX8表达证实其起源于甲状腺滤泡细胞。术后辅助同步放化疗9个月后，患者情况良好，无癌症复发的临床、生化及影像学证据。这是一例不寻常的间变性甲状腺癌病例，因为它是所报道的最大的间变性甲状腺癌肿瘤之一，表现出轻度的病理行为和相对长期的患者生存。
