Anaplastic Transformation of Metastatic Papillary Thyroid Carcinoma in a Cervical Lymph Node: a Timeline and Short Review
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Anaplastic thyroid cancer (ATC) is accepted as the transformation of a pre-existing glandular papillary thyroid carcinoma (PTC). Anaplastic transformation of a neck PTC metastasis in a lymph node is extraordinary. We present a patient with an exceptional timeline of an untreated neck PTC recurrence in a lymph node and its rare anaplastic transformation. A 68-year-old patient with PTC and neck metastasis, (stage III/II 7th/8th American Joint Committee on Cancer [AJCC], respectively) underwent thyroidectomy and neck dissection in July 2010, followed with radioiodine treatment (150 mCi) (August 2010). He received an additional 150 mCi in June 2012, because an iodine scan suggested right neck recurrence. In October 2013, an ultrasound revealed a 2.3 cm, suspicious right neck lymph node (level II–III). Yet only in 2017, after growing to 2.7 cm, the patient consented for a fine needle aspiration. PTC was verified, yet intervention was declined. In June 2018, he presented with a rapid growing neck mass occupying right levels II, III, carotid artery encasement and jugular vein involvement. A large bore needle biopsy revealed a highly malignant tumor, surrounded by necrosis, positive for cytokeratin (CK MNF 116), thyroid lineage marker (PAX8), negative for TTF-1 and thyroglobulin, i.e., ATC. The patient deceased in November 2018. This unique "natural history" of an untreated patient with PTC neck recurrence in a lymph node demonstrated a rare, yet a possible long-term consequence of anaplastic transformation. This case study, in addition to the sparsity of reported information, may advocate treating PTC neck recurrence.
Abstract
Anaplastic thyroid cancer (ATC) is accepted as the transformation of a pre-existing glandular papillary thyroid carcinoma (PTC). Anaplastic transformation of a neck PTC metastasis in a lymph node is extraordinary. We present a patient with an exceptional timeline of an untreated neck PTC recurrence in a lymph node and its rare anaplastic transformation. A 68-year-old patient with PTC and neck metastasis, (stage III/II 7th/8th American Joint Committee on Cancer [AJCC], respectively) underwent thyroidectomy and neck dissection in July 2010, followed with radioiodine treatment (150 mCi) (August 2010). He received an additional 150 mCi in June 2012, because an iodine scan suggested right neck recurrence. In October 2013, an ultrasound revealed a 2.3 cm, suspicious right neck lymph node (level II–III). Yet only in 2017, after growing to 2.7 cm, the patient consented for a fine needle aspiration. PTC was verified, yet intervention was declined. In June 2018, he presented with a rapid growing neck mass occupying right levels II, III, carotid artery encasement and jugular vein involvement. A large bore needle biopsy revealed a highly malignant tumor, surrounded by necrosis, positive for cytokeratin (CK MNF 116), thyroid lineage marker (PAX8), negative for TTF-1 and thyroglobulin, i.e., ATC. The patient deceased in November 2018. This unique "natural history" of an untreated patient with PTC neck recurrence in a lymph node demonstrated a rare, yet a possible long-term consequence of anaplastic transformation. This case study, in addition to the sparsity of reported information, may advocate treating PTC neck recurrence.
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