Endocrine Abstracts

Goals

The purpose of this work is to study histological, clinical, and therapeutic features neuroendocrine carcinomas of the thyroid.

Materials and methods

We report a case of neuroendocrine carcinoma of the thyroid colliged in ENT department of sousse.

Observation

The case involved an 83-year-old woman with a history of family dysthyroidism who had significant cervical swelling, rapidly increasing in size over the past month, and associated signs of compression (inspiratory dyspnea, dysphagia, and dysphonia). The clinical examination showed an anterolateral cervical swelling, poorly limited, fixed in relation to both planes, more marked on the right side with altered laryngeal mobility. The chest CT scan revealed a latero-cervical 9 cm mass, extended to the anterior mediastinum, pushing back the esophagus and the trachea, and compressing the carotid artery, left subclavian and right internal jugular which is thrombosed, cervical lymphadenopathy: right spinal (20mm) and right upper clavicular (17 mm). There weren’t lung parenchyma abnormalities. A biopsy showed a neuroendocrine carcinoma little differentiated expressing chromogranin. The abdominal ultrasound did not object to remote metastasis. The multidisciplinary staff opted for external radiotherapy. The evolution was marked by the rapid increase of the size of the tumor with a significant alteration of the general state. A tracheotomy was performed in emergency before the aggravation of dyspnea. The patient died before she could begin radiotherapy.

Conclusion

Clinical presentation of neuroendocrine carcinomas is aggressive and rapidly progressive with an often invasive tumor and extensive necrosis sites. The immunohistochemical study confirms the diagnosis by showing an expression of neuroendocrine markers. The lymph nodes are almost constant. Given the rarity of this histological type, the treatment remains poorly defined. However, radiation therapy is still more appropriate than surgery. The prognosis is often bad with a high mortality rate.