Nagpal Ruchi, Kaushal Manju, Kumar Sawan
Senior Resident, Department of Pathology, PGIMER, Dr RML Hospital, New Delhi, India.
Professor, Department of Pathology, PGIMER, Dr RML Hospital, New Delhi, India.
J Clin Diagn Res. 2017 Jul;11(7):ED03-ED05. doi: 10.7860/JCDR/2017/28531.10132. Epub 2017 Jul 1.
Anaplastic Thyroid Carcinoma (ATC) is a relatively uncommon highly malignant tumour originating from the follicular cells of thyroid gland having poor prognosis. It accounts for 2% to 5% of all thyroid carcinomas and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 53-year-old male presented with diffuse neck swelling measuring 8x6 cm and right cervical lymph node measuring 2x2 cm since one month which was associated with dyspepsia and dyspnoea. Ultrasound and Contrast Enhanced Computed Tomography (CECT) neck revealed enlarged right lobe of thyroid and multiple enlarged cervical lymph nodes with soft tissue density nodules in bilateral lungs. Fine Needle Aspiration (FNA) from the swelling revealed giant cell, spindle cell and squamoid pattern. Focal areas showed follicular epithelial cells arranged in repeated microfollicular pattern suggesting an underlying follicular neoplasm. FNAC smears from the lymph node also revealed similar findings. Based on the cytomorphological and radiological findings, final diagnosis of ATC probably arising from underlying follicular carcinoma with cervical lymph node and lung metastasis was given. FNAC leads to prompt and definitive diagnosis, so that therapy can be initiated as soon as possible for better outcome. Multimodality therapy (surgery, external beam radiation, and chemotherapy) is the mainstay of treatment.
间变性甲状腺癌（ATC）是一种相对罕见的高恶性肿瘤，起源于甲状腺滤泡细胞，预后较差。它占所有甲状腺癌的2%至5%，患者通常表现为前颈部肿块迅速增大并伴有侵袭性症状。一名53岁男性自一个月前出现弥漫性颈部肿胀，大小为8×6厘米，右侧颈部淋巴结大小为2×2厘米，伴有消化不良和呼吸困难。颈部超声和增强计算机断层扫描（CECT）显示甲状腺右叶增大，双侧颈部多个肿大淋巴结，双肺有软组织密度结节。对肿胀部位进行细针穿刺抽吸（FNA），结果显示为巨细胞、梭形细胞和鳞状模式。局部区域显示滤泡上皮细胞呈重复的微滤泡模式排列，提示存在潜在的滤泡性肿瘤。对淋巴结进行的细针穿刺抽吸活检（FNAC）涂片也显示了类似结果。根据细胞形态学和影像学检查结果，最终诊断为可能起源于潜在滤泡癌并伴有颈部淋巴结和肺转移的ATC。FNAC可实现快速明确诊断，从而能够尽快开始治疗以获得更好的治疗效果。多模式治疗（手术、外照射放疗和化疗）是主要的治疗方法。
