Anaplastic Thyroid Carcinoma versus Metastatic SCC: A Diagnostic Dilemma in a Rare Presentation of Post-Radiation Thyroid Swelling

Abstract

A 71-year-old male with type 2 diabetes and hypertension was diagnosed with carcinoma of the pyriform fossa in 2019. The biopsy was reported as a moderately differentiated squamous cell carcinoma, and positron emission tomography-computed tomography (PET-CT) scan showed an fluorodeoxyglucose (FDG)-avid lesion in the pyriform fossa and the aryepiglottic fold with few nodes in level II and level III. The paitent was treated with radical chemoradiotherapy. A follow-up PET-CT scan done in 2022 revealed an FDG-avid soft tissue thickening in the left palatine tonsillar region and an uptake in the thyroid that was reported as not significant. A punch biopsy from the tonsillar fossa lesion revealed squamous cell carcinoma. The lesion was treated as a second primary and treated with radiotherapy with curative intent. The patient was complaining of dysphagia, difficulty in breathing, and weight loss around 6 months after treatment that were addressed medically. There was a significant reduction in size and FDG activity of the ill-defined thickening in the left tonsillar region which was seen in the response-assessment PET done 6 months after RT. A heterogeneously enhancing nodules were seen in both lobes of the thyroid in which the largest one measured 3.5 × 3.1 cm seen in the right lobe. The patient underwent a biopsy from the thyroid that revealed a benign thyroid gland infiltrated by clusters and nests of poorly differentiated malignant cells. The histomorphology was suggestive of a poorly differentiated carcinoma, likely anaplastic carcinoma thyroid, or metastasis of the squamous cell carcinoma. Curative treatment was ruled out in this case due to his comorbidities, pulmonary symptoms, and radiation delivered to the neck.

Keywords

anaplastic thyroid carcinoma - medical oncology - metastatic squamous cell carcinoma - nuclear medicine - pathology - radiation oncology

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms.

Financial Support

None.

The manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and that each author believes that the manuscript represents honest work, if that information is not provided in another form.

Criteria for inclusion of authors—Case management, data collection, proofreading the content.

Data Sharing Statement

All data generated and analyzed during this study are included in this published article. Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

Publication History

Article published online:
21 March 2024

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