Sen Masaomi, Ito Ryo, Abe Takeshi, Kazusaka Hiroko, Matsui Mami, Saitou Marie, Nagaoka Ryuta, Jikuzono Tomoo, Sugitani Iwao
Department of Endocrine Surgery, Nippon Medical Musashi Kosugi Hospital, 1-383 Kosugi-Cho Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan.
Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Surg Case Rep. 2024 Aug 19;10(1):190. doi: 10.1186/s40792-024-01991-x.
Papillary thyroid carcinoma rarely undergoes anaplastic transformation. Some risk factors for anaplastic transformation of thyroid cancer are known, but such transformation is difficult to predict in practice. We report a case demonstrating elevations of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) over time as a precursor to anaplastic transformation of thyroid carcinoma.
The patient was an 89 year-old woman with a history of chronic aortic dissection. She was referred to our department after her local doctor detected thyroid nodules. She had previously been found to have multinodular goiter and enlarged left cervical lymph nodes on computed tomography. Her chief complaint was cervical discomfort and hoarseness. Blood tests revealed: white blood cells (WBCs), 4900 /µL; CRP, 0.29 mg/dL; neutrophils, 64.4%; and lymphocytes, 25.4%. A 21 mm mass was identified in the upper left lobe. Left III (16 mm) and left VI (16 mm) lymph node were enlarged on ultrasonography. Fine-needle aspiration cytology diagnosed malignant papillary carcinoma. However, due to the advanced age and medical history of the patient, a non-surgical policy was implemented. The primary tumor grew to 4 cm in diameter by 9 months after diagnosis, and blood tests showed: WBC, 7700 /µL; CRP, 0.18 mg/dL; neutrophils, 65.3%; and lymphocytes, 22.3%. By 10 months after diagnosis, the tumor had increased rapidly in diameter to 8 cm, with blood tests showing: WBC, 6500 /µL; CRP, 1.01 mg/dL; neutrophils, 68.2%; and lymphocytes, 19.3%. Anaplastic transformation of papillary thyroid carcinoma was diagnosed, and the patient was placed on treatment under a policy of best supportive care. Multiple lung metastases appeared 11 months after diagnosis, and blood test results showed: WBC, 13,300 /μL; CRP, 11.28 mg/dL; neutrophils, 93.6%; and lymphocytes, 2.3%. Unfortunately, the patient died of disease progression 63 days after identification of undifferentiated metastasis.
Chances to see the natural history of anaplastic transformation of thyroid cancer are rare. Elevations in NLR and CRP over time may be precursors to anaplastic transformation.
甲状腺乳头状癌很少发生间变性转化。甲状腺癌间变性转化的一些危险因素是已知的，但在实际中这种转化很难预测。我们报告一例病例，显示中性粒细胞与淋巴细胞比值（NLR）和C反应蛋白（CRP）随时间升高，作为甲状腺癌间变性转化的先兆。
患者为一名89岁女性，有慢性主动脉夹层病史。当地医生检测到甲状腺结节后，她被转诊至我科。此前计算机断层扫描发现她患有多结节性甲状腺肿和左颈部淋巴结肿大。她的主要症状是颈部不适和声音嘶哑。血液检查结果显示：白细胞（WBC）4900/μL；CRP 0.29mg/dL；中性粒细胞64.4%；淋巴细胞25.4%。在左上叶发现一个21mm的肿块。超声检查显示左III区（16mm）和左VI区（16mm）淋巴结肿大。细针穿刺细胞学诊断为恶性乳头状癌。然而，由于患者年龄较大且有病史，实施了非手术治疗策略。诊断后9个月，原发肿瘤直径增长至4cm，血液检查显示：白细胞7700/μL；CRP 0.18mg/dL；中性粒细胞65.3%；淋巴细胞22.3%。诊断后10个月，肿瘤直径迅速增大至8cm，血液检查显示：白细胞6500/μL；CRP 1.01mg/dL；中性粒细胞68.2%；淋巴细胞19.3%。诊断为甲状腺乳头状癌间变性转化，患者接受最佳支持治疗策略下的治疗。诊断后11个月出现多发肺转移，血液检查结果显示：白细胞13300/μL；CRP 11.28mg/dL；中性粒细胞93.6%；淋巴细胞2.3%。不幸的是，患者在发现未分化转移后63天因疾病进展死亡。
观察甲状腺癌间变性转化自然病程的机会很少。NLR和CRP随时间升高可能是间变性转化的先兆。
