PMC3170804_01
Preoperative computed tomography (CT) of the anaplastic thyroid carcinoma. (a) Axial view with contrast revealing a heterogeneous mass that is intimately associated with the trachea and pushes it toward the left side of the neck but free of the common carotid artery and the esophagus. (b) Coronal view with contrast demonstrating the craniocaudal extent and intimate tracheal involvement of the tumor.
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Computed tomography (CT) scan confirmed a large mass in his right neck arising from the right thyroid lobe, measuring 5.4 x 5.2 x 9.1 cm (Figure 1).
Postoperative histopathology of the resected tumor. (a) The thyroid tumor featured large zones of necrosis (right) (hematoxylin and eosin, x100). (b) The tumor was composed of highly pleomorphic cells with large, bizarre nuclei containing prominent nucleoli and mitotic figures. Much of the tumor was infiltrated by neutrophils, a common feature of anaplastic thyroid carcinoma (hematoxylin and eosin, x400). While the predominant pattern of the tumor was pleomorphic/giant cell, there were areas that were spindled (c) hematoxylin and eosin, x200) or epidermoid (d) hematoxylin and eosin, x200). (e) Focally admixed with the undifferentiated tumor was a well-differentiated oncocytic component (hematoxylin and eosin, x200). (f) The well-differentiated component transitioned directly into the predominant anaplastic component. The anaplastic carcinoma was positive for cytokeratins AE1/AE3 (g) (AE1/AE3 immunohistochemistry, x200) and PAX8 (h) (PAX8 immunohistochemistry, x200). (i) The well-differentiated component of the tumor (right) expressed thyroid transcription factor-1, while the anaplastic component (left) did not (thyroid transcription factor-1 immunohistochemistry, x200).
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Histological evaluation revealed an infiltrative malignant neoplasm with zones of geographic tumor necrosis (Figure 2(a)). ATC (Figure 2(b)). Although the neoplasm had a predominantly giant cell pattern, there were also areas of spindled (Figure 2(c)) and epidermoid (Figure 2(d)) histology. Focally admixed with the undifferentiated tumor was also a well-differentiated oncocytic component (Figure 2(e)), which was localized centrally in the middle of the tumor, accounting for about 10% of the entire tumor. The well-differentiated component transitioned directly into the predominant anaplastic component (Figure 2(f)). The anaplastic carcinoma was positive for cytokeratins AE1/AE3 (Figure 2(g)) and PAX8 (Figure 2(h)). Only the well-differentiated component but not the anaplastic component of the tumor expressed thyroid transcription factor-1 (Figure 2(i)).