Anaplastic carcinoma of the thyroid.A review of 84 cases of spindle and giant cell carcinoma of the thyroid

Abstract

Eighty-four cases of spindle and giant cell carcinoma of the thyroid were reviewed. This is a swiftly growing, and rapidly fatal neoplasm that generally develops in the elderly. Treatment of this disease was generally unsuccessful with a 7.1% five-year survival rate and a mean survival period of 6.2 months from the time of tissue diagnosis. In the majority of cases, areas of well-differentiated thyroid carcinoma could be identified, supporting the concept that spindle and giant cell carcinoma results from the transformation of preexisting well-differentiated thyroid carcinoma. Because of the aggressive biologic activity of this neoplasm, we treat all cases as disseminated disease at the time of presentation. Our best therapeutic results have been obtained with a combination of surgery, irradiation, and chemotherapy; however, these results still leave much to be desired. Patients with only small foci of spindle and giant cell carcinoma, at the time of diagnosis, may have a better chance of prolonged survival.

Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival

“…Tumors Ͻ 6 cm in size have been documented to have a better prognosis than larger tumors, 4,5,18 especially those that are only microscopic foci. 9,10 In our series, only one patient had a focus of ATC, which was found in a recurrence of follicular carcinoma, but extensive carcinoma remained in the neck after subtotal lobectomy, and the patient died 5 months after diagnosis. The presence of synchronous distant metastases correlated adversely with survival by univariate analysis, and this expected result has been shown in prior studies.…”

The Role of Cell Cycle Regulatory Protein, Cyclin D1, in the Progression of Thyroid Cancer

“…Tall cell and columnar cell variants of papillary carcinoma tend to occur in older patients and are often larger tumors with an increased incidence of vascular invasion and frequent extrathyroidal extension (27,28). Insular carcinoma is a poorly differentiated carcinoma with an intermediate morphology and clinical behavior between the differentiated (papillary) carcinoma of the thyroid and anaplastic carcinoma (29,30). Anaplastic (undifferentiated) carcinoma of the thyroid PC, Papillary carcinoma; FC, Follicular carcinoma; TCV, Tall cell variant; CCV, Columnar cell variant.…”

Evidence that one subset of anaplastic thyroid carcinomas are derived from papillary carcinomas due to BRAF and p53 mutations

“…2 A large portion of ATCs are identified in patients who have longstanding goiters or incompletely treated papillary or follicular thyroid cancers. 3,4 Careful histopathologic examination of ATC reveals that many of them contain a papillary structure or follicular components in focal areas. It is believed that ATC is derived from the follicular epithelial cells and represents a terminal dedifferentiation of preexisting differentiated carcinoma.…”