Unusual Manifestation of Anaplastic Thyroid Cancer

Abstract

The most frequent clinical manifestation of anaplastic thyroid cancer is a rapidly enlarging mass at the frontal part of the neck. It is accompanied by severe compression symptoms such as dysphagia and dyspnoea with hoarseness, which could be partially due to paresis of the recurrent laryngeal nerve. We treated a patient with symptoms consistent with a retropharyngeal abscess -swelling of the posterior pharyngeal wall, odynophagia, pain in the left side of the neck, elevated inflammatory markers. The diagnosis of anaplastic thyroid cancer was unexpectedly made after surgery and a subsequent histological examination. Case reportAn 80-year-old woman was referred to Dpt. of Otolaryngology, Head and Neck Surgery, Charles University Medicine Faculty, Teaching Hospital in Hradec Králové from a local hospital where she was treated for suspected urine infection. She suffered from chronic hypertension and insulin-dependent diabetes mellitus and diabetes mellitus was not perfectly compensated. Regarding her family history, there was one relevant piece of information concerning the death of her daughter at the age of 52 from pancreatic cancer.Odynophagia and pain in the left side of the neck appeared during the hospitalization in the local hospital accompanied with significant weight loss. Inflammation markers were significantly elevated (C-reactive protein 239 mg/l, leucocytes 25x10 9 /l). Due to the clinical findings, a computer tomography investigation (CT) was performed and a retropharyngeal abscess was found as well as hypertrophy of the left lobe of the thyroid gland. The existence of a tumour was considered as well and the patient was transferred to Dpt. of Otolaryngology, Head and Neck Surgery, Charles University Medicine Faculty, Teaching Hospital in Hradec Králové.At the time of admission the patient had pronounced swelling of the left side of her neck. It seemed to be the left lobe of the thyroid gland with retrosternal extension. We could also see swelling of the posterior pharyngeal wall, Summary: Introduction: The authors present a rare case of a patient with symptoms consistent with retropharyngeal abscess. The diagnosis of anaplastic thyroid cancer was made after surgery and subsequent histological examination. Case report: An 80-year-old woman was referred to Dpt. of Otolaryngology, Head and Neck Surgery, Charles University Medicine Faculty, Teaching Hospital in Hradec Králové with odynophagia and pain in the left side of the neck. The patient had pronounced swelling of the left side of her neck. We could also see swelling of the posterior pharyngeal wall, more pronounced on the left side. Inflammation markers were markedly elevated. Administration of antibiotics intravenously (amoxicillin combined with clavulan acid and gentamicin) was started. A computer tomography investigation (CT) was performed and a retropharyngeal abscess was found. The existence of a tumour was considered as well. An acute endoscopic examination and a puncture of the retropharyngeal space at the site of the swelling were performed,...

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

“…Requisite laboratory studies include a complete blood count and differential to evaluate for anemia, assess adequacy of platelets, and to discern any underlying leukocytosis suggestive of active infection (86) or diminished white blood cell components indicating immunodeficiency. It should be noted that rare ATC patients present with marked leukocytosis consequent to tumor secretion of lymphokines (87,88).…”

Anaplastic Thyroid Cancer: A Rare Entity Presented Clinically Only with Fever and Elevated CRP

“…To our knowledge, only one other case of ATC was presented with elevated inflammation markers among other symptoms up to this date in international bibliography (Table 1) (4).…”

“…Most often it originates from unrecognized differentiated thyroid cancer. However, it could also arise spontaneously, with no previous tumor of lower grade present (4). The most frequent clinical manifestations of ATC may be a rapidly enlarging neck mass, dyspnea, dysphagia, neck pain, Horner's syndrome, stroke, and hoarseness due to vocal cord paralysis (5).…”

Sudden massive neck swelling due to hemorrhage of a thyroid adenoma: a case report

“…An aneurysm was also excluded from the differential diagnosis on the basis of the CT scan and the ultrasound of the neck. The differential diagnosis included the spontaneous rupture of a parathyroid adenoma, accompanied by an extracapsular hemorrhage [8,9]. In such cases, severe abnormalities in the blood calcium levels are typically observed.…”

“…This pathology coexists with abnormal calcium levels. A case of lateral neck swelling caused by anaplastic thyroid cancer has also been described in the literature [8]. Rapidly progressive malignancies, such as lymphomas or sarcomas, could manifest with similar clinical characteristics.…”