Well differentiated thyroid carcinoma is associated with prolonged survival in terms of decades and anaplastic carcinoma is associated with survival in months. Intermediate malignancy with a more guarded prognosis is also known to exist.
The aim was to describe the case of a patient with a mixed papillary, poorly differentiated and anaplastic thyroid carcinoma.
A female patient, aged 73 years presented with a multinodular goiter and associated lymphadenopathy. A near total thyroidectomy was performed with lymph node dissection. On histology a diffuse thyroid carcinoma was observed. It was found to have areas of papillary differentiation, areas of insular architecture and areas of anaplastica carcinoma, multiple psammoma bodies and foci of fibrosis and calcification. Multiple neoplasmatic emboli were noted within the blood vessels and massive metastatic disease in the lymph nodes. The carcinoma was found to invade the surgical limits of dissection. A whole body scan was performed with 131I which was negative. She was given 100 mCi 131I. On follow up she developed metastatic disease in the area of the neck.
Multinodular goiter is known to be a risk factor for the development of thyroid cancer and in some cases the development of anaplastic carcinoma. Carcinogenesis in the thyroid is known to be a multi-step procedure. Papillary thyroid carcinoma is sometimes dedifferentiated to forms of carcinoma with less favorable prognosis. In the case described areas of papillary carcinoma were found along with areas of insular carcinoma and areas of anaplastic carcinoma. As predicted by the histology and the massive metastatic disease the clinical course of the patient was not favorable. In this extremely rare case of thyroid carcinoma the multi-step procedure of carcinogenesis is characteristically depicted in the histological findings.