Anaplastic transformation of thyroid cancer in mesentery metastases presenting as intestinal perforation: a case report

Abstract

Background Anaplastic thyroid carcinoma is a highly aggressive form of thyroid cancer associated with a very poor prognosis. Anaplastic transformation most commonly occurs in the thyroid itself or within regional lymph nodes. Here we report the case of a patient with papillary thyroid cancer, presenting with colon perforation as a result of anaplastic transformation of metastases in the mesentery tissue. There have been no previous reports of this form of anaplastic transformation. Case presentation A 74-year-old man was admitted to our hospital, presenting with abdominal pain that he had been experiencing for 1 week prior to admission. The patient had a history of papillary thyroid carcinoma, for which he underwent a total thyroidectomy and mediastinal lymph node dissection 6 years earlier, and subsequently received radioactive iodine therapy for postoperative recurrence in the lung 2 years later. During the present reported admission, a computed tomography scan revealed a large intra-abdominal mass infiltrating into the colon and retroperitoneum and also highlighted the pneumoperitoneum. The patient was diagnosed with generalized peritonitis as a result of colon perforation, as such, we conducted an emergency laparotomy. Intraoperative findings showed a mass affecting the ascending colon and kidney, following which, an ileostomy and biopsy were completed. Poorly differentiated spindle cells were identified in the biopsy specimens, and histopathological and immunohistochemical findings revealed the absence of thyroid carcinoma cells. The tumor was therefore believed to be a primary sarcoma. Following surgery, the patient recovered from sepsis that had arisen as a result of colon perforation, however, rapidly developed systemic metastases and died 1 month post-operation. An autopsy was performed, and the patient was diagnosed with anaplastic papillary thyroid cancer at the mesentery site of metastasis. This conclusion was reached owing to the presence of the squamous differentiation of lymph node cells, and because tumor cells were positive results for paired-box gene 8 expressions. Conclusions Anaplastic transformation of papillary thyroid carcinoma should be considered in the diagnosis of a large mesentery mass in patients with a history of papillary carcinoma. An appropriate biopsy and paired-box gene 8 immunostaining can be useful in confirming such a diagnosis.

Hurthle Cell Thyroid Carcinoma with Liver and Paraaortic Abdominal Nodal Metastasis: Progression on Sorafenib Therapy after Initial Disease Stabilization

“…4 Similar was followed in our case but the liver and abdominal nodal metastases are rare. Only a few such reports exist in the literature: (i) Meyer et al 5 reported pelvic nodal mass in insular carcinoma, while (ii) anaplastic transformation of papillary thyroid cancer in form of mesenteric mass was reported by Hosoda et al 6 ; but our case showed the unique observation of bilateral paraaortic nodal metastases in HCTC. As noted in this case, lack of adequate RAI concentration, a common observation in HCTCs precludes the use of powerful RAI therapy.…”

Small bowel perforation and death caused by anaplastic thyroid carcinoma metastasis in a patient with concomitant colonic and bilateral breast carcinoma.

“…Generally, symptomatic metastases of extraabdominal malignancies in the intestines are rare. Regarding small bowel metastasis of thyroid carcinoma, we found five references in the medical literature [15][16][17][18][19] -all are related to ATC, three of them presented with intestinal perforation, [17][18][19] as in our case. The most common primary tumors metastasizing to the small bowel are lung carcinomas and malignant melanoma, [43][44][45][46][47][48] followed by renal cell carcinoma.…”

“…49,50 Rare cases of testicular seminoma, 51 osteosarcoma, 52,53 and Ewing sarcoma 54 have also been described. Symptoms of intestinal metastasis described in the literature include intussusception, 16,[20][21][22][23][24][25][26][27][28][29][43][44][45][46][47][48][49][50][51][52][53][54] and perforation [17][18][19][30][31][32][33][34][35][36][37][38][39][40][41][42] . The curative treatment of ATC is multimodal and consists of surgery and external beam radiation therapy with radio-sensitizing chemotherapy.…”

Anaplastic Transformation of Follicular Thyroid Carcinoma in Pulmonary Metastasis With Gradually Progressive Intra-tumoral Cavitation: A Case Report

“…However, a small subset of PTC and FTC cases transform into anaplastic carcinoma. Anaplastic transformation occurs within primary tumors [ 3 ], metastatic lymph nodes [ 4 ], and metastatic lesions in distant organs [ 5 ]. Patients with anaplastic transformation have a poor prognosis, with six-month survival rates of only 35% [ 6 ].…”