Vithana Smp, Udayakumara Ead, Gunasena Mdp, Mushraf Mlm
Department of Surgery, National Hospital Kandy, Kandy, Sri Lanka.
SAGE Open Med Case Rep. 2022 Apr 14;10:2050313X221091399. doi: 10.1177/2050313X221091399. eCollection 2022.
Anaplastic thyroid carcinoma accounts for 3%-4% of thyroid malignancies worldwide and is aggressive in nature with a median survival of 6 months at diagnosis. A 67-year-old lady with a hard goitre presented with compressive symptoms and mild hypothyroidism. Ultrasound scan revealed a Thyroid Imaging Reporting and Data System 5 lesion with suspicious left-sided cervical lymphadenopathy. Anaplastic carcinoma was diagnosed by fine needle aspiration cytology. Left-sided thyroid tumour with possible carotid sheath infiltration and left-sided cervical lymphadenopathy was seen on contrast-enhanced computed tomography of the neck. She underwent total thyroidectomy with therapeutic bilateral selective central and lateral cervical lymphadenectomy. Involvement of the aero-digestive tract and carotid sheath was not observed intra-operatively. Histology reported anaplastic carcinoma with deposits of papillary carcinoma in affected lymph nodes. Oncological management was commenced thereafter. Anaplastic thyroid carcinoma usually presents as advanced disease. However, current guidelines suggest a multimodal approach comprising of curative surgery whenever feasible with adjuvant radiotherapy and chemotherapy. For patients with stage IV/IV loco-regional disease as in our patient, total thyroidectomy with therapeutic lymphadenectomy to achieve R0/R1 resection plus adjuvant therapy is the current accepted practice. For locally advanced disease, surgery maybe opted after down-staging. The aim is to resect tumour wholly and not merely de-bulking. The presence of papillary carcinoma in lymph nodes points towards anaplasia occurring in a background of differentiated thyroid carcinoma in our patient similar to what literature suggests. This has implications in post-operative thyroxine suppression and radioiodine ablative therapies.
间变性甲状腺癌占全球甲状腺恶性肿瘤的3%-4%，其本质上具有侵袭性，诊断时的中位生存期为6个月。一名67岁患有坚硬甲状腺肿的女性出现压迫症状和轻度甲状腺功能减退。超声扫描显示甲状腺影像报告和数据系统5类病变，左侧颈部淋巴结可疑。通过细针穿刺细胞学诊断为间变性癌。颈部增强计算机断层扫描显示左侧甲状腺肿瘤可能侵犯颈动脉鞘，左侧颈部淋巴结肿大。她接受了全甲状腺切除术及双侧选择性中央区和侧颈部治疗性淋巴结清扫术。术中未观察到气道消化道和颈动脉鞘受累。组织学报告为间变性癌，受累淋巴结中有乳头状癌沉积物。此后开始了肿瘤学治疗。间变性甲状腺癌通常表现为晚期疾病。然而，目前的指南建议采用多模式方法，只要可行，包括根治性手术，并辅以放疗和化疗。对于像我们的患者这样患有IV/IV期局部区域疾病的患者，目前公认的做法是进行全甲状腺切除术及治疗性淋巴结清扫术以实现R0/R1切除并辅以辅助治疗。对于局部晚期疾病，可在降期后选择手术。目的是完全切除肿瘤，而不仅仅是减瘤。淋巴结中存在乳头状癌表明我们的患者的间变性是在分化型甲状腺癌的背景下发生的，这与文献报道相似。这对术后甲状腺素抑制和放射性碘消融治疗有影响。
