A 95-year-old woman with leucocytosis and eosinophilia: anaplastic carcinoma in an ectopic thyroid

Abstract

A 95-year-old woman had been treated over the past 8 years for progressive dysphagia. When her condition worsened, blood tests revealed the presence of leucocytosis and eosinophilia in the absence of anaemia or thrombocytopenia. Within 11 days of diagnosis, the patient died of respiratory failure. Necropsy showed normal thyroid tissue and an absence of infectious disease. However, an upper mediastinal tumour was found and was histopathologically diagnosed as a neoplastic transformation of the ectopic thyroid. Only 1% of endothoracic goitres present as ectopic or autonomous goitre with no parenchymal or vascular connection to the thyroid gland. This case represents a very rare situation in which a leukemoid reaction and peripheral hypereosinophilia were observed as a manifestation of an anaplastic thyroid carcinoma in an ectopic mass.

Hypereosinophilia in Solid Tumors—Case Report and Clinical Review

“…Among the one hundred previously reported and analyzed by us cases of TABE, the death of 68 patients was reported ( 4 , 7 , 8 , 10 – 14 , 16 – 22 , 24 – 28 , 30 , 32 , 34 – 37 , 39 , 44 , 46 – 51 , 53 – 60 , 65 , 67 – 69 , 71 , 72 , 74 – 76 , 82 – 88 , 94 – 96 ). About 90% of the deaths occurred within one year after the diagnosis of paraneoplastic hypereosinophilia.…”

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

“…In additional to these clinical elements that are directly connected to the presence of the mediastinal lesion, highly aggressive malignancy in EMTs might be detected due to local or distant malignant spreading as the first step of further undergoing EMT identification. Here, we introduce the cases with thyroid cancer in EMTs (regardless of the scenario of detection) according to our methods [36,37,41,42,55,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] (Table 2).…”

“…Table 2. Case reports of EMT underlying different types of malignancy according to our methods; the display starts with the most recent publication date [36,37,41,42,55,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72]. Regardless of the pathological traits, awareness of EMTs is essential, while removal was decided in most of the cases (rather than conservative approach) depending on the location and EMT anatomical features; the risk of malignancy (the rate of conversion from benign to a malignant EMT is not clearly understood, especially in long standing goiter-like EMT); the ectopic tissue enlargement with compressive symptoms/signs such as respiratory obstruction or compression on mediastinal organs; the risk of hemorrhage [84]; the patient's co-morbidities and medical/surgical history as well as the general health status [7,13].…”

“…One short note: 19 papers introduced a single case report per article [36,37,41,42,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] and another publication presented two patients [55], leading to a total of 21 patients with any type of malignancy in EMTs. Specifically, primary thyroid cancer was identified in 20 patients (plus, a case of a one newborn displayed an immature teratoma hosted by the EMT [68]).…”

“…Specifically, primary thyroid cancer was identified in 20 patients (plus, a case of a one newborn displayed an immature teratoma hosted by the EMT [68]). Demographic features (N = 19, mean age of 62.94 years) showed a female to male ratio of 9 to 10 (for one subject, these data were not available [41]); the female group (N = 9) had a mean age of 63.4 years (range: 36 to 95 years); the male group (N = 10) had an average age of 66 years (range: 34 to 90) [36,37,42,55,[58][59][60][61][62][63][64][65][66][67][69][70][71][72].…”