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-430
Edgar Torres-Garcia*
District University Hospital, Medical Center of Puerto Rico, San Juan, PR
Case of a 57 y/o female patient with medical history of chronic tobacco use (1.5 PPD for 44 years) who was referred from ENT services due to weight loss and left anterior neck mass > 3 cm of one year evolution. No family history of thyroid CA and no previous history of head/neck irradiation. Neck MRI and CT scan done revealed left neck anterior mass involving thyroid,  trachea and surrounding tissue, also lymphadenopathy present worrisome for metastatic disease. FNA done on mass showed a poorly differentiated carcinoma. Later emergency tracheostomy done with a larger biopsy of the mass revealed a papillary thyroid carcinoma not amenable for surgical resection for which 35 cycles of radiotherapy need to be given. After radiotherapies a total laryngectomy including hyoid bone and total thyroidectomy done. Pathology report revealed a PTC lesion of 2.5 cm with capsule and lymphovascular invasion. WBS done after last surgery negative for increase uptake. No radioablation given due to no iodine uptake. But increasing trend on thyroglobulin levels noted for which case need to discussed on Endo-Cytopathology conferences in view of possible squamous cell carcinoma of neck vs. papillary thyroid carcinoma. Pathology of thyroidectomy revised and showed papillary arragement in some areas and poorly differentiated epithelial cells in other areas. Also noted areas of fibrosis, follicular cells with pseudoinclusions, grooving, calcifications and psammoma bodies. Also immunoperoxidase stains positive for thyroglobulins TTF-1, CK 18 consistent with a papillary thyroid carcinoma. All previous characteristics showed an aggressive papillary thyroid cancer. In view of no iodine uptake on area, RAI not been considered at this moment as therapy option, for which patient referred for possible monoclonal antibody therapy. This case represents how an aggressive papillary thyroid poorly differentiated carcinoma with extensive neck invasion can be confused with other neck malignancies. Physicians should recognize that a relative common thyroid CA which is usually well differentiated and with good prognosis can be a very aggressive/invasive tumor. Proper pathological identification of this malignancy is very important to start a timely possible curative treatment. More studies are needed to asses efficacy and safety of monoclonal antibody therapy in this type of thyroid CA.

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