Endocrine Abstracts

Introduction: The connection between the pharynx and thyroid is close, so in the situations of concomitance: thyroid nodules and pharynx infiltration is very difficult to establish the primary lesion. Extralaryngeal spread of laryngopharyngeal cancer to the thyroid gland can occur by three pathways: direct extension, lymphatic spread or hematogenous spread. Of these three mechanisms, direct extension is the main mechanism because of the close anatomical relationship of the thyroid gland to the laryngopharyngeal region. In the same way the thyroid cancer spread to laryngopharyngeal region also mainly by direct infiltration of the tumor.

Aim: To present a rare case of hypopharyngeal cancer (typical for men aged 55–70 years with a history of tobacco use and/or alcohol ingestion) in a relative young female patient with nodular goiter as first symptom.

Case report: A 48 years old woman with dysphagia and throat pain for past 4 months presented at clinical examination a large goiter (nodules over 2 cm in size in both lobes). Neck ultrasound outlines two round thyroid nodule (one for each lobe) situated in the superior poles close to the thyroid capsule: ACR TI-RADS score 5 points. The indirect laryngoscopy described total left and partial right vocal cord paralysis and computer tomography investigation revealed massive hypopharynx infiltration. Due to the ACR TI-RADS score, a fine needle aspiration biopsy from both thyroid nodules was performed and the histological result displayed only squamous cells with no thyreocites. Hypopharynx biopsy confirmed squamous cell carcinoma and the patient underwent tracheostomy and enteral feeding due to the important and rapid local obstruction. In addition she underwent palliative radiotherapy and chemotherapy.

Conclusion: Thyroid gland involvement is not common in hypopharyngeal squamous cell carcinoma. Cases that involved the post-cricoid area, subglottic extension, extralaryngeal spread are associated with a higher risk of thyroid gland invasion. The particularity of our case consist in the presence of hypopharyngeal cancer in a relativ young female alredy with local metastases in the thyroid gland. Besides the two options: thyroid cancer with hypopharyngeal infiltration or hypopharyngeal carcinoma with thyroid metastasis a third hypothesis would have been plausible: papillary thyroid cancer coexisting with squamous cell carcinoma of the upper aerodigestive tract.