Department of Otolaryngology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
BMJ Case Rep. 2021 Mar 1;14(3):e241209. doi: 10.1136/bcr-2020-241209.
A 57-year-old woman presented with a 3-month history of an enlarging thyroid mass causing breathlessness and dysphagia. Cross-sectional imaging showed a thyroid tumour infiltrating the trachea and abutting the oesophagus. She underwent panendoscopy, total thyroidectomy and planned tracheal resection, but due to intraoperative findings, a staged procedure was planned instead. Histological analysis revealed a poorly differentiated squamous cell carcinoma (SCC) which was positive on paired box gene 8 (PAX8) immunostaining, suggesting a diagnosis of primary thyroid SCC. She subsequently underwent total laryngectomy and bilateral neck dissections followed by radiotherapy with concurrent cisplatin chemotherapy. The patient remains disease-free 22 months after treatment. Median overall survival is 10 months for macroscopically completely resected tumours. PAX8 immunostaining is a novel technique which helps with the diagnostic challenge of distinguishing between primary thyroid SCC and SCC metastatic to the thyroid from extrathyroidal sites. Complete surgical resection with adjuvant chemoradiotherapy may result in a favourable outcome despite conflicting reports in the literature.
一位 57 岁女性因甲状腺肿块增大导致呼吸困难和吞咽困难，病史 3 个月。横断面成像显示甲状腺肿瘤浸润气管并紧贴食管。她接受了全甲状腺切除术和计划中的气管切除术，但由于术中发现，改为分期手术。组织学分析显示分化不良的鳞状细胞癌（SCC），配对盒基因 8（PAX8）免疫染色阳性，提示原发性甲状腺 SCC 的诊断。随后，她接受了全喉切除术和双侧颈部清扫术，随后进行了顺铂化疗同步放疗。治疗后 22 个月患者无疾病。对于大体完全切除的肿瘤，中位总生存期为 10 个月。PAX8 免疫染色是一种新的技术，有助于解决鉴别原发性甲状腺 SCC 和来自甲状腺外部位 SCC 转移至甲状腺的诊断难题。尽管文献中有相互矛盾的报道，但完全手术切除加辅助放化疗可能会产生良好的结果。
