Endocrine Abstracts

The aim of this study is to report a case of an unusual presentation of anaplastic thyroid carcinoma and describe its clinical, radiological and management particularities. Observation: We report the case of a 60 year-old female patient who presented with a two-week history of progressive aphagia, associated with hemoptysis. She also described recent shortness of breath, and a painless cervical mass evolving for 10 months, rapidly enlarging during the last four weeks. Her medical history was uneventful. Physical examination found bilateral fixed hard masses of the cervical sectors II and III, measuring 5 cm on the left, and 10 cm on the right with an extension to sector III. Nasofibroscopy revealed a suspect left subtonsillar mass, hiding the hypopharyngeal and laryngeal structures. Its biopsy showed unspecific necrotic tissues. CT scan objected a hypopharyngeal mass, measuring 102×78×62 mm, extending inferiorly to the larynx, posteriorly to the prevertebral space, invading anteriorly the right thyroid lobe and reaching laterally the subcutaneous tissues. Multiple cervical necrotic lymph nodes and thrombosis of the right internal jugular vein were associated. On thoracic images, pulmonary metastases were found. Due to aggravation of her dyspnea, the patient underwent tracheotomy, during which a second biopsy was done. Anatomopathological study with immunohistochemistry (PAX8, cytokeratin and TTF1) discovered an anaplastic thyroid carcinoma. Palliative radio and chemotherapy were indicated, but the patient was lost of sight. Conclusion: Considering the rapidly lethal potential of anaplastic thyroid carcinomas, it is important to have in mind this entity as a differential diagnosis for head and neck tumors.