anaplastic thyroid carcinoma

(redirected from undifferentiated thyroid carcinoma)

anaplastic thyroid carcinoma

The most aggressive of all thyroid malignancies, which accounts for only 2–5% of thyroid carcinomas but 40% of thyroid cancer-related deaths. The typical history is of a rapid increase in size of a long-standing cold thyroid nodule in an elderly patient; it is more common in iodine-deficient geographic regions and in a background of prior thyroid pathology (e.g., goitre or thyroid cancer); up to 80% have a history of well- (papillary, follicular) or poorly differentiated thyroid carcinoma. Local invasion (e.g., trachea, oesophagus) is common.

Clinical findings
Hoarse voice, cough, haemoptysis, tracheal obstruction; physical exam may reveal nodules in thyroid.

Lab
Thyroid function is usually normal.

Diagnosis
Biopsy.
 
Management
Generally palliative; 50% are inoperable at the time of diagnosis; surgery, radiation and chemotherapy are essentially useless.

Prognosis
Anaplastic carcinoma is an aggressive disease with early metastases in lung (50% of cases), bone and brain; median survival is 4­–6 months.
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Histologically, undifferentiated thyroid carcinomas show a variety of patterns, from sheet-like, storiform, fascicular, angiomatoid, and meningothelial to solid, exhibiting extensive lymph-vascular invasion.
RET rearrangements and BRAF mutation in undifferentiated thyroid carcinomas having papillary carcinoma components.
Selective activation of ras oncogenes in follicular and undifferentiated thyroid carcinomas.

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