Endocrine Abstracts

Introduction: Squamous cell carcinoma (SCC) is a very rare thyroid carcinoma with aggressive behavior and poor prognosis. Diagnostic difficulties reside in differentiating SCC from other thyroid malignancies and also in establishing its primary or secondary nature, which are both important for treatment strategy.

Case report: A 62-year-old woman, with unremarkable personal and family history, presented in October 2013 with progressive enlargement of a right neck mass with regional pain radiating toward the right ear and shoulder, hoarseness, inspiratory stridor and 10 kg weight loss in the past 2 months. Physical examination revealed a 5 cm hard, adherent thyroid nodule with impalpable inferior pole, without satellite lymph nodes. Laryngoscopy showed right vocal cord paralysis. On ultrasound the nodule was hypoechoic, with ill-defined margins, microcalcifications and necrotic areas. Contrast enhanced CT scan showed lateral impingement of neck vessels and trachea, retrosternal descent and intimate contact with the right brachiocephalic trunk. Lymph nodes or other masses were not identified (putative sites of origin or metastases). Thyroid hormones, antithyroid antibodies and calcitonin were normal, while thyroglobulin was low 1.43 ng/ml (NV 3.5–7.7). FNA cytology was inconclusive. Thyroidectomy was performed and histological examination revealed an infiltrative, malignant epithelial proliferation with keratinous foci, desmoplastic stroma, necrosis, hyalinization, and calcifications. Immunohistochemistry diagnosed SCC – focal positivity for p63, diffuse positivity for CK7, CK19, 34β E12, galectin 3 and negativity for TTF1 and CD5. The patient received three courses of Paclitaxel – 300 mg. In January 2014 thyroid recurrence was detected (three nodules up to 20 mm).

Conclusion: Future research is needed to establish a better management of patients with thyroid SCC.