Int J Thyroidol.  2020 May;13(1):55-59. 10.11106/ijt.2020.13.1.55.

Coexistent Papillary Thyroid Carcinoma and Its Anaplastic Transformation in Cervical Lymph Node Metastasis

• Song S
• Lee DH
• Kim H
• Jeong WJ

• KMID: 2502262
• DOI: http://doi.org/10.11106/ijt.2020.13.1.55

Abstract

The transformation of papillary thyroid carcinoma (PTC) to anaplastic thyroid carcinoma (ATC) is well documented in the literature but is an exceptionally rare occurrence in metastatic foci outside the primary thyroid lesion. Even rarer is the simultaneous occurrence of PTC and ATC in the cervical lymph nodes. We report the case of an 85–year–old man who presented with a rapidly growing neck mass diagnosed as PTC. Following surgery, multiple ATC foci in the metastatic cervical lymph node were found coexisting with PTC, whereas in the thyroid, only PTC was found. This case is of high clinical significance because transformation of PTC to ATC outside the thyroid gland per se is very rare and because it suggests rapidly growing tumors in an elderly patient. The use of core needle biopsies in cases with suspected rapid tumor growth can aid in proper diagnosis, surgical decision making, and patient counselling.

Keyword

Thyroid cancer; Papillary thyroid carcinoma; Lymphatic metastasis; Anaplastic transformation

Figure

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  Fig. 1 (A) Computed tomography of the neck shows a large-sized mass (2×2×3.2 cm) in the left thyroid gland (arrow). (B) Computed tomography of the neck shows the left level IV lymph node with enlarged size (4.7×3.1 cm) (arrow). (C) Positron emission tomography-computed tomography (PET-CT) scan. Hypermetabolic nodule in the left thyroid lobe. Hypermetabolic enlarged lymph nodes in left neck level III, IV, right level VI and superior mediastinum. Small nodules with hypermetabolism in both lungs. (D) PET-CT scan. Local recurrence with disseminated metastasis to lymph nodes, lungs, bones, cerebellum, left adrenal gland, and cardiac RV wall.

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  Fig. 2 Pathology finding of cervical lymph node core needle biopsy specimen. (A) The metastatic tumor composed of a minor papillary thyroid carcinoma component (left upper, red circle) and the majority of the biopsied specimen with poorly differentiated histology different from PTC; Hematoxylin & Eosin staining (H&E) ×40. (B) Immunohistochemical staining of PAX8. PAX8 was expressed only in the papillary thyroid carcinoma component (left upper, red circle) and negative in the poorly differentiated tumor component; H&E ×40. Pathology finding of surgically resected specimen. (C) Thyroid; H&E ×400. (D) Lymph node; H&E ×400.

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