Abstract
Anaplastic transformation of papillary thyroid carcinoma (PTC) at distant metastatic sites is extremely rare, and there have been fewer than 20 reported cases in the literature. A 61-year-old woman presented with 1-week history of dyspnea. Her past medical history was remarkable because, 19 years ago, she underwent nearly total thyroidectomy and radical neck dissection due to PTC. Computed tomography of the chest revealed a 1.7 cm nodule in the lung and diffuse pleural thickening. Gun biopsy of the lung nodule revealed metastatic PTC with typical histology. However, the pleural biopsy predominantly showed anaplastic pleomorphic and spindle sarcomatoid carcinoma with microscopic focus of PTC. Immunohistochemical results showed both anaplastic sarcomatoid and PTC components positive for TTF-1, galectin-3 and PAX-8, thus supporting anaplastic transformation of PTC at the metastatic site. Subsequently the patient received 1 cycle of cisplatin-based chemotherapy but died from the disease 4 months after diagnosis. Although it is rare, anaplastic transformation of PTC should be considered during differential diagnosis of patients who present with exclusive sarcomatoid morphology at metastatic sites and have a history of PTC. We report another case of anaplastic transformation of PTC, found at pleural metastasis, together with the immunohistochemical profile and a literature review.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abe T, Suzuki M, Shimizu K, Shinagawa N, Oizumi S, Matsuno Y, Miyazaki M, Tanino M, Tanaka S, Nishimura M. Anaplastic transformation of papillary thyroid carcinoma in multiple lung metastases presenting with a malignant pleural effusion: a case report. J Med Case Rep. 2014;8:460.
Swanson T, Nanthakumar S, Bugis S, Wiseman SM. Extrathyroidal anaplastic transformation. Cancer Ther. 2008;6:491–4.
Ragazzi M, Ciarrocchi A, Sancisi V, Gandolfi G, Bisagni A, Piana S. Update on anaplastic thyroid carcinoma: morphological, molecular, and genetic features of the most aggressive thyroid cancer. Int J Endocrinol. 2014;2014:790834.
Sugitani I, Miyauchi A, Sugino K, Okamoto T, Yoshida A, Suzuki S. Prognostic factors and treatment outcomes for anaplastic thyroid carcinoma: ATC research consortium of Japan cohort study of 677 patients. World J Surg. 2012;36:1247–54.
Al-Qsous W, Miller ID. Anaplastic transformation in lung metastases of differentiated papillary thyroid carcinoma: an autopsy case report and review of the literature. Ann Diagn Pathol. 2010;14:41–3.
Sotome K, Onishi T, Hirano A, Nakamaru M, Furukawa A, Miyazaki H, Morozumi K, Tanaka Y, Iri H, Mimura Y. A rare case of anaplastic transformation within the metastatic site of the retroperitoneal region in a patient 17 years after total thyroidectomy for papillary carcinoma of the thyroid beginning with multiple bone metastases. Thyroid. 2007;17:1309–11.
Solomon JP, Wen F, Jih LJ. Anaplastic transformation of papillary thyroid cancer in the retroperitoneum. Case Rep Pathol. 2015;2015:241308.
Takeshita Y, Takamura T, Minato H, Misu H, Ando H, Yamashita T, Ikeda H, Nakanuma Y, Kaneko S. Transformation of p53-positive papillary thyroid carcinoma to anaplastic carcinoma of the liver following postoperative radioactive iodine-131 therapy. Int Med. 2008;47:1709–12.
Angeles-Angeles A, Chable-Montero F, Martinez-Benitez B, Albores-Saavedra J. Unusual metastases of papillary thyroid carcinoma: report of 2 cases. Ann Diagn Pathol. 2009;13:189–96.
Kaushal S, Sharma MC, Mathur SR, Rastogi S, Bal CS, Chumber S. Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma. Indian J Pathol Microbiol. 2011;54:796–9.
Nakayama R, Horiuchi K, Susa M, Hosaka S, Hayashi Y, Kameyama K, Suzuki Y, Yabe H, Toyama Y, Morioka H. Anaplastic transformation of follicular thyroid carcinoma in a metastatic skeletal lesion presenting with paraneoplastic leukocytosis. Thyroid. 2012;22(2):200–4.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.
Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212.
Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7.
LiVolsi VA. Papillary thyroid carcinoma: an update. Mod Pathol. 2011;24(Suppl 2):S1–9.
Smallridge RC, Marlow LA, Copland JA. Anaplastic thyroid cancer: molecular pathogenesis and emerging therapies. Endocr Relat Cancer. 2009;16:17–44.
Fiscer S, Asa SL. Application of immunohistochemistry to thyroid neoplasm. Arch Pathol Lab Med. 2008;132:359–72.
Bishop JA, Sharma R, Westra WH. PAX8 immunostaining of anaplastic thyroid carcinoma: a reliable means of discerning thyroid origin for undifferentiated tumors of the head and neck. Hum Pathol. 2011;42:1873–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Kim, H., Park, Y.W., Oh, YH. et al. Anaplastic Transformation of Papillary Thyroid Carcinoma Only Seen in Pleural Metastasis: A Case Report with Review of the Literature. Head and Neck Pathol 11, 162–167 (2017). https://doi.org/10.1007/s12105-016-0751-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12105-016-0751-4