Petko Dimov, Daniel Stefanov, Tsvetan Stanimirov, Emilia Naseva
DOI: 10.5455/IJMRCR.PRIMARY-SQUAMOUS-CELL-CARCINOMA-OF-THE-Thyroid-GLAND
How to cite this article:
| Petko Dimov, Daniel Stefanov, Tsvetan Stanimirov, Emilia Naseva. PRIMARY SQUAMOUS CELL CARCINOMA OF THE THYROID GLAND - CASE REPORT AND REVIEW OF THE LITERATURE. Int J Med Rev Case Rep. 2018; 2(1): 4-6. doi:10.5455/IJMRCR.PRIMARY-SQUAMOUS-CELL-CARCINOMA-OF-THE-THYROID-GLAND |
Primary squamous cell carcinoma of the Thyroid Gland (PSCTC) is among the most aggressive forms of thyroid cancer. Although there are reports that this tumour is resistant to conservative treatment, the most effective treatment is radical surgery followed by chemotherapy and radiotherapy. Patients typically present with a massive tumour mass of solid consistency on the neck.
Case report:
We report a case of PSCTC in a 71-year-old ex-smoker with moderate obesity (BMI=31) and no history of goitre.
He was admitted to our clinic with a two-month history of progressive neck enlargement and weight loss.
During the medical evaluation, we discovered a neck deformation caused by a solid tumour mass. Normal blood tests were conducted. The MRI revealed that the entire left lobe of the thyroid gland was affected by a tumour mass that was adhered to the trachea and adjacent tissues. An operation was performed. Intraoperatively, there was a malignancy arising from the left lobe of the thyroid gland, firmly affixed to the trachea, and extending posterolaterally to the left jugular vein and the left carotid artery without clear indications of infiltration. The right lobe and isthmus were in good condition.
A lobectomy and isthmectomy were conducted on the left lung. It was impossible to see the recurrent laryngeal nerve and the parathyroid glands. A LigaSure Precise was used to remove a tumour from the trachea and the adjacent tissues. Significant thyroid vessels were sealed with the same apparatus. The tumour was excised from the left jugular vein and the left carotid artery using a blunt dissector.
The frozen section procedure yielded PSCTC as a result.
Considering the poor prognosis of the tumour, the inability to visualise the recurrent laryngeal nerve and the parathyroid glands, and the inappropriate indications of a radical surgical procedure, we deemed the total thyroidectomy to be unnecessary.
Postoperatively, a body scan was conducted on the patient, which revealed no other malignancies and no lymphadenopathy.
The patient was evacuated from the hospital in excellent condition and with preserved phonation on the third postoperative day.
The patient was diagnosed with a recurrence of tracheal pressure and respiratory difficulties three months after surgery while undergoing chemotherapy. A tumour has attained its initial dimensions. A second operation to reduce the size of the tumour was conducted to ameliorate the symptoms. On the twentieth postoperative day, another recurrence of the same size tumour was detected. The patient was referred for symptomatic treatment as no additional surgery was recommended. He passed away five months after the disease was identified.
Key points:
- Thyroid gland primary squamous cell carcinoma is a highly aggressive cancer with a poor prognosis.
- It typically affects patients in their fifth or sixth decade and has traditionally been linked to a history of goitre.
- Patients present with a swiftly expanding neck mass and symptoms of infiltration and compression of contiguous neck structures (such as dyspnea and hoarseness).
- Approximately 40% of Primary Thyroid Squamous cell carcinomas contain squamous cell areas, which are believed to be the result of metaplasia of follicular epithelial cells.
- The role and efficacy of chemoradiation in the treatment of primary thyroid squamous cell carcinomas have not been adequately investigated, but studies indicate inadequate sensitivity to chemotherapy or radiotherapy.
- Although it may not always be possible, early diagnosis and aggressive surgery aiming for radical resection are considered the best treatment options.
- The majority of primary thyroid squamous cell carcinoma patients die within a few months of undergoing surgery.
- Total thyroidectomy may be deemed unnecessary due to the increased risk of laryngeal nerve and parathyroid gland injury, and it may not enhance prognosis or survival rate.
License CC BY-NC-SA 4.0
"Primary thyroid squamous cell carcinoma is among the most aggressive forms of thyroid cancer" is a derivative of "Primary squamous cell carcinoma of the thyroid gland - case report and review of the literature" by International Journal of Medical Reviews and Case Reports used under CC BY-NC-SA 4.0.
