Unintentional discovery of a second cancer amidst laryngeal carcinoma surgery: case report of two patients

Heyfa Belhadj-Miled; Houas Jihene; Monia Ghammam; Oussama Khalfi; Omri Malika El; Abir Meherzi; Mouna Bellakhdhar; Wassim El Ghali; El Abed Yosra Hasni; Wassim Kermani; Mohamed Abdelkafi

doi:10.1530/endoabs.99.EP831

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Endocrine Abstracts (2024) 99 EP831 | DOI: 10.1530/endoabs.99.EP831

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Unintentional discovery of a second cancer amidst laryngeal carcinoma surgery: case report of two patients

Heyfa Belhadj-Miled ¹ , Houas Jihene ¹ , Monia Ghammam ¹ , Oussama Khalfi ² , Malika El Omri ¹ , Abir Meherzi ¹ , Mouna Bellakhdhar ¹ , El Ghali Wassim ³ , Yosra Hasni El Abed ⁴ , Wassim Kermani ¹ & Mohamed Abdelkafi ¹

Err

Author affiliations

¹Farhat Hached Hospital, ENT Department, Sousse, Tunisia; ²Department of Radiology, Sousse, Tunisia; ³Department of Anaesthesia, Sousse, Tunisia; ⁴Department of endocrinology, Sousse, Tunisia

Introduction: The occurrence of a differentiated thyroid carcinoma alongside a squamous cell carcinoma of the larynx is a seldom-encountered clinical phenomenon. Typically, it presents as a histological surprise, as clinical examinations and thyroid gland scans often show no abnormalities. Limited clinical cases have been documented in the literature, and the management of such cases remains a subject of significant controversy.

Material and Methods: We conducted a retrospective study involving two patients who underwent surgery for epidermoid carcinoma of the larynx, where the unexpected discovery of papillary thyroid carcinoma occurred.

Results: Two patients, aged 63 and 68, both chronic smokers, sought medical attention for progressive dysphonia and recent-onset inspiratory dyspnea. Fibroscopic examination revealed distinct lesions: an ulcerating-burgeoning lesion on the left vocal cord, fixed in the first patient, and a lesion encompassing the entire right hemilarynx, fixed in the second patient. Biopsy confirmed infiltrating, moderately differentiated squamous cell carcinoma in both cases. Tumor staging was T4N0M0 for the first patient and T4aN1 cm1 with bone and lytic lesions for the second patient. Surgical interventions included total pharyngo-laryngectomy with bilateral functional lymph node curage for both patients. In addition, the first patient underwent a left loboisthmectomy, revealing papillary thyroid carcinoma on extemporaneous examination, leading to totalization with bilateral mediastino-recurrent curage. The second patient underwent an immediate total thyroidectomy. The final pathology indicated the coexistence of squamous cell carcinoma of the larynx with papillary carcinoma of the left thyroid lobe (3.2 cm) in the first case and multiple papillary microcarcinomas involving both thyroid lobes (0.3 to 0.8 cm) in the second case. Both patients received external radiotherapy in conjunction with treatment for squamous cell carcinoma. Additionally, both patients were recommended further iratherapy and underwent a single 100 mCi ablative treatment with white mapping on scanning.

Conclusion: The coexistence of differentiated thyroid carcinoma with squamous cell carcinoma of the larynx is a rare clinical finding, often surprising from a histological standpoint. Despite normal clinical examinations and thyroid scans, few cases have been reported in the literature, and the optimal management strategy remains a subject of significant controversy.