Synchronous carcinoma of the thyroid and hypopharynx; a diagnostic and management challenge

Abstract

A 73-year-old Chinese origin woman presented with a right neck swelling associated with recent swallowing issues and hoarseness. She had an apparent goitre and a right posterior neck swelling. An ultrasound guided fine needle aspiration demonstrated papillary thyroid carcinoma in both thyroid lobes and right neck lymphadenopathy. While awaiting total thyroidectomy and neck dissection she presented with haemoptysis. She was found to have an exophytic mass in right pyriform fossa. The CT scan confirmed an intralaryngeal extension of the thyroid mass via thyroid cartilage and metastatic disease in the lung. Unexpectedly histology showed that the tissue from the right pyriform fossa was squamous cell carcinoma and papillary carcinoma in the thyroid was confirmed. She had synchronous cancers in the thyroid and hypopharynx. Synchronous tumours are a big challenge to diagnose and to treat. In her case the CT scan was misleading. We discuss this unusual presentation of synchronous head and neck cancers and difficulty in managing them.