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Abstract
Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5–20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
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Fig. 1.
Images and pathologic findings of PTC at the time of initial diagnosis. (A) PET-CT image showed a hypermetabolic mass (SUV 22.9) in the right thyroid gland. (B) Neck US showed a 1.0-cm round, rim calcified nodule in the right thyroid gland. (C) Specimen obtained by US-guided core needle biopsy and tumor cells showed typical morphology of PTC such as intranuclear inclusion, ground glass ap-pearance of nuclei and papillary growth pattern (H&E staining, original magnification ×200).
Fig. 2.
Images and pathologic findings after anaplastic trans-formation. (A) Neck US showed a 4.8-cm solid and calcified nodule in the right thyroid gland. (B) PET-CT image showed a hypermetabolic mass (SUV 29.0) in the right thyroid gland. (C) Specimen obtained by surgery and it revealed typical morphology of ATC that is patternless pleomorphic spindle cells with high mitotic count (H&E staining, original magnification ×200).
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