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Case of the Week #248

8 August 2012 - Case of the Week #248

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Case of the Week #248

Clinical History:

A 74 year old man had a total thyroidectomy for multinodular goiter. Histology showed a multinodular goiter with a 2.5 cm follicular adenoma in the isthmus. The remainder of the capsule was submitted to rule out capsular invasion (follicular carcinoma):

Micro images:

           

What is your diagnosis?































Diagnosis:

Thyroid gland: squamous cell carcinoma arising in follicular adenoma

Discussion:

The squamous cell carcinoma measured 5.5 mm. Tumor cells were strongly positive for CK5/6 and p63, and negative for TTF1 and thyroglobulin.

   
Left-CK5/6, right: TTF1

Squamous cell carcinoma of the thyroid gland is very rare, with less than 100 cases reported. It typically affects older patients with chronic goiter, who usually present with a rapidly enlarging neck mass.

The tumor cells may derive from squamous cells of the thyroglossal duct or branchial pouch remnants, or from squamous metaplasia in Hashimoto’s thyroiditis or papillary carcinoma. Squamous cell carcinoma may be part of an anaplastic carcinoma, or be associated with classic or tall cell variants of papillary thyroid carcinoma (Mod Pathol 2000;13:742).

The differential diagnosis includes extension from a laryngeal or tracheal primary or metastatic disease, which are more common and may have a better prognosis (J Laryngol Otol 2011;125:3). In the thyroid gland, metastases usually present as multiple nodules. This patient actually had prior squamous cell carcinoma in the scalp, resected approximately 20 years previously.

Squamous cell carcinoma has a poor prognosis, due to extrathyroidal extension. Death occurs in almost all cases, with a median survival of less than 6 months (Int Semin Surg Oncol 2007;4:8, Endocr J 2008;55:359). Preoperative chemotherapy and surgery may prolong survival (Head Neck 2012;34:131).

Nat Pernick, M.D., President
and Liz Parker, B.A., Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com