Unusual presentation of anaplastic thyroid carcinoma with diffuse neck and thoracic nodules and hyperthyroidism

Age increased the cancer-specific mortality risk of thyroid cancer with lung metastasis

OBJECTIVE

To investigate the relationship between age and cancer-specific mortality in thyroid cancer (TC) with lung-metastasis.

PATIENTS AND METHODS

A total of 1418 patients with initial distant metastases from Surveillance, Epidemiology, and End Results databases were investigated. Patients with a median follow-up time of 8 months (interquartile range [IQR]: 2-27] and a median age of 66 years (IQR: 55-76) were divided into five groups by age and the association between age and TC-specific mortality was analysed.

RESULTS

The TC-specific mortality rates were 32.78% (118/360), 46.71% (156/334), 53.93% (199/369), 58.96% (158/268) and 82.76% (72/87) in patients aged ≤55 years, >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years. Kaplan-Meier curves showed that TC-specific mortality rate was associated with increased age (p < .001). Compared with patients ≤55 years, patients aged >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years had significantly higher hazard ratios (HRs) of 1.69 (1.26-2.26), 1.97 (1.47-2.64), 2.18 (1.59-2.99) and 3.24 (2.08-5.06) after adjustments for sex, tumour size and radiation therapy (all p < .001). In TC with initial lung-metastasis, compared with patients ≤55 years, patients aged >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years had significantly higher adjusted HRs of 1.68 (1.20-2.36; p = .003), 2.18 (1.57-3.02), 2.16 (1.51-3.08) and 2.91 (1.79-4.75; p < .001). Similar results were obtained in papillary TC.

CONCLUSIONS

The TC-specific mortality was increased with age in TC patients with initial lung-metastasis, indicating that further risk stratification based on age was necessary for TC over 55 years with lung-metastasis. Individual treatment strategies maybe recommended for such patients.

Osteoclastic variant of anaplastic thyroid carcinoma: An insight into a rarest of rare entity

Anaplastic thyroid carcinoma is a rare and a very aggressive thyroid malignancy with a dismal prognosis. It has a short history and presents with a rapidly increasing neck mass associated with compressive symptoms like pain, hoarseness of voice, dysphagia and shortness of breath. Osteoclastic variant is an extremely rare variant, which is, characterize by presence of a large number of multinucleated giant cells, which resemble osteoclasts. Here we report two cases of this unusual variant in a 68 years old and 49 years old male with a short history of thyroid swelling.

MaalikBabu AN, Arumugam V. Interesting case of cutaneous metastases to thoracic skin from anaplastic carcinoma of thyroid: An unreported entity in India

Anaplastic thyroid carcinoma is a highly aggressive tumor with 100% mortality that constitutes 1%–2% of thyroid malignancies. Cutaneous metastases from thyroid carcinoma are extremely rare. We report a case of a 68-year-old male with anaplastic thyroid carcinoma with cervical lymph node and thoracic cutaneous metastases. Following the diagnosis of anaplastic carcinoma with stage IVB after thorough investigations, he was started on chemotherapy with cisplatin and adriamycin, and also radiotherapy was given subsequently. Dermatological examination showed a single ulcer of size 3 × 2 cm, hard nodules, and plaques of varied sizes present over the anterior chest. Skin biopsy from the nodule showed pleomorphic tumor cells in strands with colloid material and neutrophilic infiltrates in the deep dermis. The present case report demonstrates that thoracic skin metastases can occur from anaplastic thyroid carcinoma with nodules and ulcers and, to our knowledge, this is the first case report of such an extremely rare condition from India.

Metastatic propagation of thyroid cancer; organ tropism and major modulators

Thyroid cancer, as the most prevalent endocrine malignancy, comprises nearly 1% of all cancers in the world. The metastatic propagation of thyroid cancer is under the control of a number of modulating processes and factors such as signaling pathways and their components, cell division regulators, metabolic reprogramming factors, extracellular matrix remodelers, epithelial to mesenchymal transition modulators, epigenetic mechanisms, hypoxia and cytokines. Identifying the exact molecular mechanisms of these dysregulated processes could help to discover the key targets for therapeutic purposes and utilizing them as diagnostic, prognostic and predictors of the clinical course of patients. In this review article, we describe different aspects of thyroid cancer metastasis by focusing on defective genes and pathways involved in its metastatic spread.