Anaplastic thyroid carcinoma with metastases involving soft tissues of the upper and lower extremities

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 429-448-Thyroid Neoplasia & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-431
Sarah Varghese1, Sameera Tallapureddy2, Amit Bhargava*2, Aiswarya Thomas3, Melinda Sanders3 and Carl D Malchoff4
1University of Connecticut, Hartford, CT, 2University of Connecticut, Farmington, CT, 3UCONN, 4Univ of CT Hlth Ctr, Farmington, CT
Anaplastic thyroid carcinoma with metastases involving soft tissues of the upper and lower extremities.

Varghese, Sarah MD1; Tallapureddy, Sameera MD1; Bhargava, Amit MD1; Thomas, Aiswarya MD2; Sanders, Melinda MD3; Malchoff, Carl MD, PhD1.

Division of Endocrinology, University of Connecticut Health Center, Farmington CT 06030.1

Division of Primary Care and Internal Medicine, University of Connecticut Health Center, Farmington CT 06030.2

Department of Pathology, University of Connecticut Health Center, Farmington CT 06030.3

Background:  Anaplastic thyroid carcinoma (ATC) is a rare tumor that metastasizes frequently to lymph nodes, lung, bone and brain.  Distant metastases to soft tissues of the extremities have not been reported. The authors present a unique case of ATC with soft tissue metastases to the upper and lower extremities. 

Clinical Case:  A 60 year old female, with prior documentation of a right thyroid lobe nodule, presented with 3 week history of left arm and leg swelling, rapidly progressive dysphagia, hoarseness of voice and swelling of anterior neck. One year prior to presentation, she declined advice to undergo a fine needle aspiration biopsy of a 2.3cm right thyroid nodule with irregular margins.  On admission physical examination, a 6cm mass in the right thyroid lobe was producing tracheal deviation to the left.  There was swelling in the left calf and left forearm, and DVT was excluded by Doppler.  CT scan revealed esophageal compression, cervical lymphadenopathy, bilateral adrenal masses, a T5 vertebral body lesion, ring-enhancing lesions in the brain, a hepatic mass and cavitary lung lesions.  Following a near total thyroidectomy to prevent tracheal and esophageal compression, her pathology revealed ATC.   The left upper and lower extremity pain and swelling worsened.  A non-contrast CT scan of left upper and lower extremity suggested a 19x4.6x3.2cm multi-septate peripherally enhancing region of apparent fluid collection within the flexor compartment of the forearm extending from elbow to the wrist and a 5cm region of multiple ill -defined communicating apparent fluid collections within the soleus muscle.  Incision and drainage of the swollen region of the left forearm revealed ATC.  An infective work up was negative.

Conclusion: ATC is a rare and aggressive that frequently metastasizes to locally to lymph nodes, and distally to lung, bone and brain.  Less frequently metastases to skin, liver, kidneys, pancreas, heart and adrenal glands have been reported.  We conclude that ATC may metastasize to the soft tissues of the extremities.

Nothing to Disclose: SV, ST, AB, AT, MS, CDM

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