Endocrine Abstracts

Introduction: Anaplastic thyroid carcinoma are highly aggressive solid tumors, with a median survival of less than 6 months after diagnosis. They typically occur in patients who are 65 years of age or older. On the other hand, papillary thyroid carcinoma and follicular thyroid carcinoma are generally indolent, with very few progressive cases.

Case report: A 64-year-old patient with no significant pathological history, known with goiter for about 40 years but without endocrinological evaluation, presented in our department for progressive dysphonia. A total thyroidectomy was performed. Histopathological examination revealed aplastic thyroid carcinoma that associates papillary thyroid carcinoma follicular form. The patient received radioiodine therapy (June 2015) and external, cervical beam therapy (July 2016). Post-surgery, CT scan describes multiple cervical, less than 1 cm, lymph nodes, and two straight pulmonary nodules too small to be characterized, stationary imaging aspect at subsequent examinations. In March 2019, he performed a PET-CT scan that detects a left rib (C6-C7) tumor with high FDG activity – surgery was performed, and papillary metastasis was confirmed. In August 2019, it was treated with a complementary dose of radioiodine. Bone scintigraphy and CT scan performed afterward described small, nonspecific rib injuries: secondary or old post-traumatic or arthritic lesions. In this case, thoracic radiotherapy was postponed due to the high risk for secondary lung fibrosis and the uncertainty of secondary injuries. After iodine therapy, the values of thyroglobulin were undetectable both in suppression and without. It was bisphosphonate treatment and possible SORAFENIB – timed for the moment (normal thyroglobulin). In 3 months, a new CT scan, costal biopsy, or better a PET-CT scan are considered.

Conclusion: Anaplastic thyroid cancer is the rarest yet most aggressive thyroid cancer. Most patients present with a rapidly enlarging thyroid mass, and the majority die within six months of diagnosis. In our patient case, it is considered the association between anaplastic and papillary-follicular variant, with a good, unexpected evolution for the anaplastic component but with secondary dissemination for the differentiated part.

Keywords: thyroid carcinoma, management, secondary injury.