Anaplastic Thyroid Carcinoma Arising From a Calcified Thyroid Mass

摘要

A 68-year-old female presented for follow-up of a dense calcified mass in the right thyroid with a 3 -year history. An ultrasound (US) of the affected thyroid demonstrated a newly-developed hy-poechoic area (Fig 1, arrows) at the low portion of the calcified thyroid mass with multiple cervical lymphadenopathies (Fig 2) on the right side. Three years prior, a neck US incidentally detected a dense calcified mass in the right thyroid (Fig 3, arrows) without evidence of pathologic lymphadenopathy. At that time, the cyto-logic result of the calcified mass obtained using US-guided fine-needle aspiration biopsy was nondiagnostic. At the most recent follow-up, however, fine-needle aspiration biopsy of the newly-developed hypoechoic area revealed papillary carcinoma. Subsequent total thyroidectomy with bilateral neck dissection was performed. The specimen was an ill-defined lesion showing thick irregular fibrosis (blue arrows) and calcifications (yellow arrows) with a conventional papillary carcinoma area (black arrows) and solid infiltrative area (Fig 4; X12.5). The solid infiltrative area revealed highly atypical cells with polygonal or spindle and polymorphic cytoplasm and bizarre nuclei with prominent eosino-philic nucleoli (Fig 5; X 200), suggesting anaplastic transformation. After 3 months, the patient complained of palpable neck nodes. The patient underwent fluorodeoxyglucose positron emission tomography/computed tomography to evaluate the metastasis. Multiple hypermetabolic lesions were detected on the lungs, heart, neck, liver, and in the skeletal systems (Fig 6, arrows) on positron emission tomography/computed tomography. She died of an upper respiratory infection 6 months after the operation#