Int J Thyroidol.  2017 Nov;10(2):127-132. 10.11106/ijt.2017.10.2.127.

Anaplastic Transformation of Follicular Thyroid Cancer in the Lung, Liver, Bone, and Adrenal Gland

• Lee W
• Kim D

• KMID: 2396819
• DOI: http://doi.org/10.11106/ijt.2017.10.2.127

Abstract

Anaplastic transformation of differentiated thyroid cancer at distant metastatic sites is extremely rare and has a poor prognosis. It usually occurs in the thyroid gland or cervical lymph nodes. Here we report a case of anaplastic transformation arising at multiple distant metastatic sites including the lung, liver, adrenal gland, bone, and lymph nodes in a patient 3 years after total thyroidectomy for follicular thyroid cancer.

Keyword

Cell transformation; Neoplastic; Thyroid carcinoma; Anaplastic; Thyroid cancer; Follicular; Thyroid cancer; Papillary

MeSH Terms

Adrenal Glands*
Humans
Liver*
Lung*
Lymph Nodes
Prognosis
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy

Figure

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  Fig. 1 Microscopic examination of the thyroid tumor. (A) Low-power view exhibiting normofollicular (right side) and microfollicular (left side) growth patterns. Widespread infiltration of the thyroid parenchyma and multifocal vascular invasions are present (H&E staining, original magnification ×40). (B) High-power view of follicular pattern with round nuclei and fine chromatin (H&E staining, original magnification ×400). (C) High-power view of insular pattern with cleaved nuclei and mitotic activity (H&E staining, original magnification ×400).

• 

  Fig. 2 Follow-up of images during the clinical course. (A) Post-therapeutic whole body scan (RxWBS). The first RxWBS revealed no uptake at the neck but functioning metastases to the sternum and both lungs (left). The second RxWBS showed much improved metastases in both lungs compared with the first RxWBS (center). The third RxWBS showed significantly decreased uptake in the sternum (right). (B) Positron emission tomography-computed tomography (PET-CT) scan. The initial PET-CT revealed hypermetabolic lesions in the left thyroid lobe, sternal manubrium, and both lungs. The second PET-CT scan showed decreased extent and numeric changes of pulmonary nodules and no change in the sternum. The third PET-CT showed significantly decreased metabolic and extent change in the sternum. The last PET-CT scan on admission showed multiple hypermetabolic lesions in the lung; liver; left adrenal gland; along the whole body skeletal system; in and around the skin area in front of the sternum; and in the lymph nodes along the anterior mediastinal, left hilar, retrocaval, and left common iliac areas.

• 

  Fig. 3 Follow-up of thyroglobulin levels during the clinical course. Thyroglobulin levels were greatly decreased after two surgeries and three rounds of RITx. However, thereafter, thyroglobulin levels continuously increased throughout the course. Ex: excision, RAITx: radioactive iodine therapy, TSH: thyroid stimulating hormone, TT: total thyroidectomy

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  Fig. 4 Microscopic examination of the lung biopsy specimen. (A) Low-power view exhibiting diffuse infiltrate of anaplastic cells associated with extensive necrosis and acute inflammation (right side). There is a small focus of well-formed follicular architecture composed of well-differentiated follicular cells (left side) (H&E staining, original magnification ×100). (B) Higher magnification of anaplastic cells showing pleomorphic nuclei and macronucleoli (H&E staining, original magnification ×400).

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