Endocrine Abstracts

Introduction: Oncocytic tumors of the thyroid include adenomas and carcinomas. The distinction between malignancy and benignity represents a major difficulty on the histological level. From this aspect arise constraints in the attitude therapy to adopt.

Material and methods: we present one rare case of an oncocytic carcinoma of the thyroid with laryngotracheal invasion in a 54 male patient operated in ENT department of Farhat Hached hospital of Sousse.

Observation: This is the case of a 54 years old patient who presented with a left basicervical mass evolving for 6 months without other associated signs such as local compression signs or clinical dysthyroidism. There was no history of pain, fever, dysphagia or resiratory difficulties. On examination, there was a large swelling occupying the anterior basicervical region; of 3 centemeters in the right side an of 6 centemeters in the left side; with ferm, nontender, and nonpulsatile consistency. The examination did not find any cervical lymph nodes and nasofibroscopy showed normal vocal cords in aspect and in mobility. Free thyroxine (fT4) and thyroid stimulating hormone (TSH) levels were normal. Thyroid ultrasound confirmed the thyroid origin of the mass and showed no signs of malignancy. A total thyroidectomy was performed. Extemporaneous and definitive histological examination concluded to an oncocytic adenoma. Five years later, the patient came back with an anterior basicervical mass of 5 centemeters, associated with moderate dyspnea. CT scan concluded to thyroid mass of 4 centemeters with a subglottic tissue process with necrotic center of 3 centimeters. Also, pulmonary metastasis was noted. He had a direct laryncoscopy with tracheoscopy showing an infiltration of tracheal wall 2 centimeters from the glottic plane. Histological exaination of the biopsy concluded to an infiltration of the tracheal wall by an oncocytic tumor. We concluded to a recurrence of a misdiagnosed oncocytis thyroid carcinoma as an oncocytic adenoma. The patient had a tumorectomy associated to a sub-isthmic tracheotomy followed by 3 courses of radioactive iodine treatment. The patient was forseen for target therapy but wasunfortunatelylost to follow.

Conclusion: Oncocytic cell carcinoma is commonly retained as an aggressive tumor with low survival rate. Surgery is the mainstay of treatment for carcinoma and planning its appropriate initial surgical management is especially important as curative procedure.