Anaplastic thyroid carcinoma
Progressive dyspnea and dysphagia. Weight loss. Palpable neck mass.
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Large multiloculated centrally necrotic and peripherally enhancing right-sided neck mass arising from the right hemithyroid inferior pole.
There is compression of the inferior aspect of the right internal jugular vein. Filling defect extending from the level of the thyroid mass up to the level of C2/C3 within the right internal jugular vein without associated enhancement or adjacent direct tumor invasion. Findings are in favor of bland thrombus.
There is also effacement and likely invasion of the posterior trachea, with tracheal displacement anterolaterally, without any significant airway narrowing.
There is encasement of the right common carotid artery, which opacifies normally without evidence of occlusion.
The esophagus is displaced towards the left with narrowing and mural thickening.
Proximal right subclavian artery is encased by the mass with minor narrowing of its caliber and post-stenotic dilatation.
There is a peripherally enhancing round right level III lymph node with two further enhancing nodes more anteriorly. Multiple subcentimeter, enhancing left level II-IV and superior mediastinal lymph nodes are present.
An open right-sided neck biopsy was performed.
MACROSCOPIC DESCRIPTION: Two specimens received.
Right neck mass 1: Multiple irregular cream necrotic pieces of tissue measuring 20x15x4 mm in aggregate.
Right neck mass 2: Multiple tan to necrotic pieces of tissue measuring 15x15x8 mm in aggregate.
MICROSCOPIC DESCRIPTION: Both biopsies show similar appearances, comprising fibroadipose tissue that is infiltrated by a largely necrotic tumor comprising sheets of discohesive and pleomorphic malignant epithelial cells with cytoplasmic vacuolation and mucoid material in the background.
Immunohistochemistry: AE1/AE3+, CD3-, CD20-, CD30-, TTF1-, CK7 focal weak+, CK20-, CK5/6-, PSA-, thyroglobulin-, BRAF V600E-, ALK-.
The features are those of a poorly differentiated carcinoma that would be compatible with anaplastic thyroid carcinoma.
DIAGNOSIS: Undifferentiated carcinoma, compatible with anaplastic thyroid carcinoma.