Concurrent Anaplastic and Papillary Thyroid Carcinomas: A Case Report

Abstract

Anaplastic thyroid cancer (ATC) is a rare, but extremely aggressive, form of cancer with a high mortality rate. Differentiated thyroid cancer (DTC), on the other hand, including papillary and follicular subtypes, are relatively common and typically follows a more indolent course. Cases have been reported in which ATC transforms from DTC, and where DTC and ATC exist simultaneously. Given the low incidence of such cases, they have not been well studied, and the optimal treatment regimen has yet to be determined. We present a case of a 77year-old woman who was initially presented with papillary thyroid cancer (PTC) with focal ATC. Five months after undergoing total thyroidectomy, she returned with a new right sided neck mass. Fine needle aspiration (FNA) with biopsies of the mass and lymph node at one level revealed a smear pattern consistent with ATC. However, lymph node biopsy taken from a different level revealed a smear pattern consistent with PTC. Mutation analysis was performed and results were positive for metastatic BRAF V600-mutant ATC. The patient was then started on dabrafenib/trametinib chemotherapy. Seven months later, she was tolerating treatment well. These unique clinical features including the initial presentation and the relatively favorable survival, that is more than double that of the median survival rate for ATC, suggests that those with synchronous PTC and ATC may have a more indolent course with better prognosis than those with ATC alone. It is also possible that the relatively longer survival in our patient is due to the use of the BRAF inhibitor, dabrafenib and the MEK inhibitor, trametinib in this case with concurrent ATC and PTC. While patients with both PTC and ATC have been documented to have mutations in the BRAF V600 gene, the objective of this report is to present the relatively favorable outcomes when a therapeutic regimen is guided by mutation analysis. Future research into advanced treatment options including targeted therapy and /or immunotherapy for both DTC and ATC is needed. Somatic mutation testing may also be helpful to identify oncogenic kinase abnormalities that will inform therapeutic decision making.

Concurrent Anaplastic and Papillary Thyroid Carcinoma Manifesting as a Thyrocutaneous Fistula

“…ATC is the most aggressive form of thyroid malignancy, with studies showing a high mortality rate of 33-50%, a median survival of three to four months, and less than 20% survival of one year [1][2][3][4]. Most patients will present with sudden enlarging of neck mass, and no less than 40% of the patients have distant metastases at the time of diagnosis [1].…”

“…Differentiated thyroid carcinoma (DTC), on the other hand, including follicular and papillary subtypes, are more common. Papillary thyroid carcinoma (PTC) alone accounts for 85% of all thyroid carcinomas [ 3 ]. Here, we report a case of thyroid carcinoma with concurrent anaplastic and follicular variants of the papillary subtype component presenting as thyrocutaneous fistula with pus discharge.…”

Papillary thyroid carcinoma occurring with undifferentiated pleomorphic sarcoma: A case report

“…This combination is approved by the FDA, and a central radiology review demonstrated an overall response rate of 69%[ 21 ]. In one patient, dabrafenib/trametinib therapy was well tolerated, and the patient lived for more than six months[ 22 ]. To date, no medications targeting TERT or telomerase have been developed.…”

Nanoparticles: Promising Auxiliary Agents for Diagnosis and Therapy of Thyroid Cancers

“…ATC is usually diagnosed after it has already spread and is one of the most incurable cancers. The tumors can be very complex, with 20-30% of ATC patients having tumor areas with ATC and PTC histology [15]. Malignant bone and cartilage formation has also been observed and the descriptive term "carcinosarcoma" as subtype of ATC has been suggested by the WHO but this classification is not uniformly accepted.…”