PMC10225731_01
The pathology of the patient. (A) Well-differentiated thyroid papillary carcinoma at initial. (B) Anaplastic change from papillary carcinoma of the right neck lymph node. The anaplastic carcinoma is composed of tumor cells in a nested pattern with markedly enlarged pleomorphic and hyperchromatic nuclei and an eosinophilic cytoplasm. Typical papillary carcinoma-like nuclear features (ground glass and grooving) are absent. The stroma is richly infiltrated with inflammatory cells.
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Postoperative pathology revealed that the right thyroid mass was classic papillary carcinoma ( Figure 1A ). Pathological results of core needle biopsy confirmed that the right neck mass was undifferentiated thyroid carcinoma, CK(+),TTF-1(focal +),TG(focal +),PAX8(+),CD117(-),CD5(-),CgA(-),Syn(-),Calcitonin(-)PTH(-),P63(-), Ki-67 60%( Figure 1B ).
(A) The right neck mass, about 26cm*18cm*15cm in size, locally ruptured and bled in June 2021. (B) After radiotherapy and immunotherapy, the patient's neck mass shrank, as shown above in July 2022.
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The patient presented to our hospital with a large, locally ruptured and bleeding thyroid mass in June 2021.The bleeding volume of the mass was approximately 100 ml per day, resulting in severe anemia ( Figure 2A ). Her neck mass was gradually reduced in size after radiotherapy and tislelizumab immunotherapy. ( Figure 2B ).
The map of the patient's radiotherapy target volume. (A) transverse position (B) sagittal position (C) coronal position. The dose was 6750 cGy in the red part (GTVboost) and 4500 cGy (GTV) in the yellow part.
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The patient received radiation therapy with a prescription of 4500 cGy in 15 fractions to the right neck mass and 6750 cGy in 15 fractions to the tumor boost (the target area of radiotherapy shrunk the edge of the mass by 1 cm and avoided the large blood vessels and nerves and other tissues) using a simultaneous integrated boost technique, IMRT IGRT ( Figure 3 ).
The serial CT images of the patient before and after treatment with radiotherapy and tislelizumab immunotherapy. (A) CT image of right neck lymph node recurrence in June 2021(baseline). (B) CT image of the right neck lymph node in July 2021 after radiotherapy. (C) CT image of the right neck lymph node in October after tislelizumab immunotherapy. (D) CT image of the right neck lymph node in March 2022. It showed the tumor shrank. (E) CT image of the right neck lymph node in July 2022. (F) CT image of the right neck lymph node in October 2022.
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Serial CT images of the patient are shown in ( Figure 4 ).