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Anaplastic Thyroid Carcinoma

Thyroid Cancer Anaplastic Carcinoma

Anaplastic carcinoma of the thyroid (ATC) is a type of thyroid cancer, which has the worst prognosis amongst all thyroid malignancies. It is known to progress rapidly and is responsible for nearly half of the deaths that result from thyroid cancer.


Presentation

Anaplastic thyroid carcinoma (ATC) is considered a fatal type of cancer as the average survival period after diagnosis is approximately 4 months [1] [2]. Patients who are affected by ATC are primarily elderly with an average age of 70 years [3].

Individuals present both with non-specific symptoms and signs which are clinically indicative of the diagnosis of thyroid malignancy. Amongst the former are a non-productive cough, dyspnea and neck pain [4]. A quickly growing neck mass may have already been noticed by the patient, and dysphagia is a symptom that can be considered more specific to a thyroid pathology. Other symptoms may be observed, such as Horner's syndrome, which encompasses the triad of hemifacial anhidrosis, miosis, and partial blepharoptosis; a recently acquired hoarse voice may also be reported, due to local invasion of the vocal cords [4].

Unfortunately, studies have documented as many as 50% of the patients as being diagnosed at a time when distant metastases have already developed [5] [6]. Skeletal and pulmonary malignant metastatic invasion is the most common type, and those individuals complain of bone pain and pulmonary symptoms. Invasion of the brain parenchyma by cancer cells will lead to various neurological symptoms and regional enlargement of lymph nodes indicates a metastasis to adjacent structures. Weakness, malaise, and weight loss may also be reported as a general complaint and symptoms resulting from liver, kidney, pancreas, heart or the adrenal gland may also be reported since these organs also constitute probable sites for metastasis.

Goiter
  • We report a rare case of a 66-year-old woman, who had had the preexisting large, euthyroid multinodular goiter for almost 50 years.[ncbi.nlm.nih.gov]
  • It typically found in 40% of places where goiter is endemic.[ccij-online.org]
Thyroid Nodule
  • An ultrasonographic control, performed 10 months before diagnosis, showed the onset of a shell calcification all around the thyroid nodule that forbade the performance of FNAB.[ncbi.nlm.nih.gov]
  • Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.[emedicine.medscape.com]
Weight Loss
  • He developed recent symptoms of dyspnea, dysphagia, neck welling and uniintentional weight loss. Computed tomography of the neck was done revealing a large MNG with retrosternal extension and calcifications.[ncbi.nlm.nih.gov]
  • Weakness, malaise, and weight loss may also be reported as a general complaint and symptoms resulting from liver, kidney, pancreas, heart or the adrenal gland may also be reported since these organs also constitute probable sites for metastasis.[symptoma.com]
  • Clinically, anaplastic thyroid carcinoma often presents as a quickly growing and firm lesion in the neck, and it may be associated with vocal cord paralysis, hoarseness, weight loss, and dyspnea [1,5].[path.upmc.edu]
  • Clinical case: A 78 year-old woman with no prior history of thyroid disorders presented to the hospital with 3 weeks' history of severe dyspnea, dysphagia and hoarseness, with a 20-lb weight loss.[endocrine.org]
  • She did not give history of fever, night sweats, or weight loss. On physical examination, she was afebrile and tachypneic. A hard-fixed swelling of 2 2 cm with normal overlying skin was found in right cervical region, which moved with deglutition.[lungindia.com]
Asymmetric Thyroid Enlargement
  • Rarely, rapid growth of the tumor within the thyroid causes thyroiditis, with symptoms of hyperthyroidism and more severe neck pain and tenderness Signs — On physical examination, most patients have bilateral but asymmetric thyroid enlargement.[aboutcancer.com]
Hoarseness
  • In this case report, a 51 y old male presented with a 2-week history of hoarseness and was diagnosed with ATC.[ncbi.nlm.nih.gov]
  • Other symptoms may be observed, such as Horner's syndrome, which encompasses the triad of hemifacial anhidrosis, miosis, and partial blepharoptosis; a recently acquired hoarse voice may also be reported, due to local invasion of the vocal cords.[symptoma.com]
  • Clinically, anaplastic thyroid carcinoma often presents as a quickly growing and firm lesion in the neck, and it may be associated with vocal cord paralysis, hoarseness, weight loss, and dyspnea [1,5].[path.upmc.edu]
  • Definition / general Undifferentiated (high grade) carcinoma of thyroid gland 2 - 5% of thyroid cancers but 40% of thyroid cancer deaths Rapidly enlarging, bulky neck mass invades adjacent structures causing hoarseness, dysphagia, dyspnea Most thyroid[pathologyoutlines.com]
Stridor
  • Five of 26 patients (19%) had stridor at presentation. A further 6 of 26 patients (23%) developed stridor during or soon after radiotherapy. Nine patients (36%) died of airway obstruction.[ncbi.nlm.nih.gov]
  • Stridor is harsh-sounding breathing caused by a restricted airway. Thyroid function tests are usually normal. Return to top of page Progression ATC can progress in different individuals in different ways. Here is a typical scenario.[thyca.org]
  • Most patients with ATC demonstrate local compressive symptoms including dysphagia, dysphonia, stridor, dyspnea, and neck pain and tenderness [ 6 ].[ispub.com]
  • Other findings of local extension of the disease include stridor, tracheal deviation, and vocal cord paralysis due to compression or invasion of the trachea; and venous dilatation and superior vena cava syndrome due to retrosternal tumor growth.[aboutcancer.com]
  • Patients usually present with a rapidly enlarging mass and symptoms like stridor, dysphagia, vocal cord paralysis, neck pain and dyspnea.[ro-journal.biomedcentral.com]
Tracheal Deviation
  • Other findings of local extension of the disease include stridor, tracheal deviation, and vocal cord paralysis due to compression or invasion of the trachea; and venous dilatation and superior vena cava syndrome due to retrosternal tumor growth.[aboutcancer.com]
Mediastinal Disease
  • Although the respiratory difficulty, fever, and marked granulocytosis subsequently improved, she died 1 month after undergoing surgery due to metastatic mediastinal disease.[ncbi.nlm.nih.gov]
Productive Cough
  • Amongst the former are a non-productive cough, dyspnea and neck pain. A quickly growing neck mass may have already been noticed by the patient, and dysphagia is a symptom that can be considered more specific to a thyroid pathology.[symptoma.com]
Dysphagia
  • Despite a total thyroidectomy, the tumor recurred within one month and caused dysphagia and death. FNAB permitted the diagnosis of an anaplastic thyroid carcinoma arising from an intrathoracic Hürthle cell tumor.[ncbi.nlm.nih.gov]
  • Suspicion of thyroid malignancy, including ATC, is raised when a patient presents with a growing neck mass, dysphagia, neck pain, and cough.[symptoma.com]
  • Definition / general Undifferentiated (high grade) carcinoma of thyroid gland 2 - 5% of thyroid cancers but 40% of thyroid cancer deaths Rapidly enlarging, bulky neck mass invades adjacent structures causing hoarseness, dysphagia, dyspnea Most thyroid[pathologyoutlines.com]
Esotropia
  • A 52-year-old woman presented with decreased vision, diplopia, esotropia, proptosis, and right orbital pain. Clinical examination was suspicious for an orbital mass and additionally revealed a thyroid gland mass.[ncbi.nlm.nih.gov]
Blepharoptosis
  • Other symptoms may be observed, such as Horner's syndrome, which encompasses the triad of hemifacial anhidrosis, miosis, and partial blepharoptosis; a recently acquired hoarse voice may also be reported, due to local invasion of the vocal cords.[symptoma.com]
Neck Mass
  • Herein, we report a case of a 34 year old male who presented with a progressively enlarging neck mass.[ncbi.nlm.nih.gov]
  • Suspicion of thyroid malignancy, including ATC, is raised when a patient presents with a growing neck mass, dysphagia, neck pain, and cough.[symptoma.com]
Encephalopathy
  • Posterior reversible encephalopathy syndrome (PRES) is a rare reversible neurological syndrome that causes subcortical vasogenic brain edema and which is associated with the use of target-specific agents.[ncbi.nlm.nih.gov]
Excitement
  • CONCLUSIONS: The data open the exciting prospect of NIS-mediated radionuclide imaging and therapy of ATC after non-viral reintroduction of the NIS gene.[ncbi.nlm.nih.gov]

Workup

A thorough workup for ATC includes a complete medical history, serum laboratory testing, a thoracic radiograph, an ultrasonographic scan (US scan), a positron emission tomography/computerized tomography (PET/CT), a CT scan and a biopsy.

Suspicion of thyroid malignancy, including ATC, is raised when a patient presents with a growing neck mass, dysphagia, neck pain, and cough. A complete blood count (CBC) and standard biochemical profile are the first blood laboratory tests carried out, even though results may not directly point to ATC. TSH levels are mandatory and so is a neck US scan, that can help to initially evaluate the mass and illustrate lymph node invasion [4]. Blood calcium levels can differentiate between an ATC and parathyroid malignancy or medullary thyroid cancer.

Other imaging modalities that are usually employed encompass a CT scan of the neck, that can assess the extent of the tumor and possible local metastasis [7]. CT is a modality that can be used to investigate further, distant metastasis. A fine-needle aspiration biopsy is a test that can render an accurate diagnosis; typical histological features of an ATC are:

ATC requires a meticulous differentiation from thyroid lymphoma. This can be done with the aid of cytoplasmic immunoglobulin measurement and gene rearrangement studies. Thoracic radiography is performed to detect pulmonary metastasis. Lastly, a PET-CT scan is of great value, in order to evaluate distant metastases [8].

Lymphocytic Infiltrate
  • The presence of a pre-existing tumor, epithelial growth, a squamous cell carcinoma component, no neutrophilic infiltration and lymphocytic infiltration may therefore be favorable prognostic factors in anaplastic thyroid carcinoma.[ncbi.nlm.nih.gov]
Brain Edema
  • Posterior reversible encephalopathy syndrome (PRES) is a rare reversible neurological syndrome that causes subcortical vasogenic brain edema and which is associated with the use of target-specific agents.[ncbi.nlm.nih.gov]

Treatment

  • Inverse treatment planning provides superior dose optimization for the treatment of anaplastic thyroid carcinoma. The radiobiologic impact of intensity modulation for this tumor should be further tested clinically.[ncbi.nlm.nih.gov]

Prognosis

  • Patients with ATC have a bad prognosis. Distant metastases, surgery, radiotherapy and tumor residue are the most important factors affecting the prognosis.[ncbi.nlm.nih.gov]

Etiology

  • Therefore, it is essential to elucidate the etiology of eosinophilia in patients with thyroid cancer in order to improve the treatment for patients with anaplastic thyroid carcinoma.[ncbi.nlm.nih.gov]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • […] differentiated thyroid carcinoma (papillary, follicular or Hürthle cell carcinoma); most cases have a core of conserved mutations in well differentiated and anaplastic areas, plus increases in mutation rates in anaplastic areas ( Am J Surg Pathol 2003;27:1559 ) Etiology[pathologyoutlines.com]
  • (Etiology) As with the other types of thyroid cancer, the cause of Anaplastic Thyroid Cancer is currently unknown. Anaplastic Thyroid Cancer occurs when healthy cells of the thyroid become cancer cells, as a result of genetic mutations.[dovemed.com]
  • The etiology of ATC is heterogeneous. It has been found out, that genetic components as well as a lack of iodine, radiation, female sex and nicotine abuses are important factors.[ro-journal.biomedcentral.com]

Epidemiology

  • This was a retrospective cohort report structured according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guideline.[ncbi.nlm.nih.gov]
  • Our primary aim was to review its epidemiology, biology, risk factors, and prognostic indicators. We also reviewed the individual and combined roles of surgery, radiotherapy, chemotherapy, and newer therapeutic options in the management of ATC.[link.springer.com]
  • Jump to navigation Jump to search Epidemiology [ edit ] 2% of thyroid cancers 13-39% thyroid cancer deaths F M 3:1 Mean age of diagnosis is 65 Pathophysiology [ edit ] Thought to be a de-differentiation of a previously differentiated thyroid cancer. 20%[en.wikibooks.org]
  • Epidemiology Anaplastic (undifferentiated) carcinoma of the thyroid gland is uncommon, accounting for less than 5% of all cases of thyroid carcinoma.[atlasgeneticsoncology.org]
Sex distribution
Age distribution

Pathophysiology

  • We challenge current ideas regarding the biochemical pathophysiology of rapid thyrotoxicosis in anaplastic thyroid carcinoma and provide an alternative explanation.[ncbi.nlm.nih.gov]
  • The pathophysiology is consistent with thyroiditis, and thus anti-thyroid drugs are ineffective. Corticosteroids should be the medication of choice for treating hyperthyroidism associated with anaplastic thyroid cancer (1,2).[endocrine.org]
  • Pathophysiology Anaplastic carcinoma of the thyroid (ATC) generally occurs in people in iodine-deficient areas and in a setting of previous thyroid pathology (eg, preexisting goiter, follicular thyroid cancer, papillary thyroid cancer).[emedicine.medscape.com]
  • […] carcinoma, giant cell carcinoma, pleomorphic carcinoma Epidemiology Mean age 70 years, female to male ratio of 2:1 Median 1 year survival rate: 10 - 20% Sites Often presents with local and distant metastases All are considered high stage (IV) tumor Pathophysiology[pathologyoutlines.com]

Prevention

  • China. 3 Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin National Clinical Research Center for Cancer, Tianjin 300060, P.R.[ncbi.nlm.nih.gov]

References

Article

  1. Kebebew E, Greenspan FS, Clark OH, Woeber KA, McMillan A. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer. 2005;103:1330–1335.
  2. Gilliland FD, Hunt WC, Morris DM, Key CR. Prognostic factors for thyroid carcinoma. A population-based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973-1991. Cancer. 1997;79:564–573.
  3. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma: treatment outcome and prognostic factors. Cancer. 2005;103:1330–1335.
  4. Keutgen XM, Sadowski SM, Kebebew E. Management of anaplastic thyroid cancer. Gland Surg. 2015;4:44–51.
  5. Thompson LD, Wieneke JA, Paal E, et al. A clinicopathologic study of minimally invasive follicular carcinoma of the thyroid gland with a review of the English literature. Cancer. 2001;91:505–524.
  6. Sherman SI. Anaplastic carcinoma: Clinical aspects. In: Wartofsky L, Van Nostrand D, editors. Thyroid Cancer: A Comprehensive Guide to Clinical Management. 2nd. Totowa, NJ: Humana Press; 2006. pp. 629–632.
  7. Takashima S, Morimoto S, Ikezoe J, et al. CT evaluation of anaplastic thyroid carcinoma. AJR Am J Roentgenol. 1990;154:1079–1085.
  8. Bogsrud TV, Karantanis D, Nathan MA, Mullan BP, Wiseman GA, Kasperbauer JL, et al. 18F-FDG PET in the management of patients with anaplastic thyroid carcinoma. Thyroid. 2008 Jul; 18(7):713-9.

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Last updated: 2019-07-11 20:18