Concurrent Anaplastic and Papillary Thyroid Carcinomas: A Case Report

Samara Skwiersky¹, Gil Hevroni¹, Gurbaj Singh¹, Lisel Hope¹, Tahmineh Haidary², Moro O. Salifu¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, SUNY- Downstate Health Science University, Brooklyn, New York, United States- 11203

²Department of Pathology, SUNY- Downstate Health Science University, Brooklyn, New York, United States- 11203

Cite this paper

Samara Skwiersky, Gil Hevroni, Gurbaj Singh, Lisel Hope, Tahmineh Haidary, Moro O. Salifu and Samy I. McFarlane. Concurrent Anaplastic and Papillary Thyroid Carcinomas: A Case Report. American Journal of Medical Case Reports. 2020; 8(7):202-205. doi: 10.12691/AJMCR-8-7-11

Abstract

Anaplastic thyroid cancer (ATC) is a rare, but extremely aggressive, form of cancer with a high mortality rate. Differentiated thyroid cancer (DTC), on the other hand, including papillary and follicular subtypes, are relatively common and typically follows a more indolent course. Cases have been reported in which ATC transforms from DTC, and where DTC and ATC exist simultaneously. Given the low incidence of such cases, they have not been well studied, and the optimal treatment regimen has yet to be determined. We present a case of a 77-year-old woman who was initially presented with papillary thyroid cancer (PTC) with focal ATC. Five months after undergoing total thyroidectomy, she returned with a new right sided neck mass. Fine needle aspiration (FNA) with biopsies of the mass and lymph node at one level revealed a smear pattern consistent with ATC. However, lymph node biopsy taken from a different level revealed a smear pattern consistent with PTC. Mutation analysis was performed and results were positive for metastatic BRAF V600- mutant ATC. The patient was then started on dabrafenib/trametinib chemotherapy. Seven months later, she was tolerating treatment well. These unique clinical features including the initial presentation and the relatively favorable survival, that is more than double that of the median survival rate for ATC, suggests that those with synchronous PTC and ATC may have a more indolent course with better prognosis than those with ATC alone. It is also possible that the relatively longer survival in our patient is due to the use of the BRAF inhibitor, dabrafenib and the MEK inhibitor, trametinib in this case with concurrent ATC and PTC. While patients with both PTC and ATC have been documented to have mutations in the BRAF V600 gene, the objective of this report is to present the relatively favorable outcomes when a therapeutic regimen is guided by mutation analysis. Future research into advanced treatment options including targeted therapy and /or immunotherapy for both DTC and ATC is needed. Somatic mutation testing may also be helpful to identify oncogenic kinase abnormalities that will inform therapeutic decision making.

Keywords

anaplastic thyroid cancer, papillary thyroid cancer, concurrent

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	O’neill, J.P. and A.R. Shaha, Anaplastic thyroid cancer. Oral Oncology, 2013. 49(7): p. 702-706.
[2]	Sipos, J.A. and E.L. Mazzaferri, Thyroid Cancer Epidemiology and Prognostic Variables. Clinical Oncology, 2010. 22(6): p. 395-404.
[3]	Simões-Pereira, J., et al., Anaplastic Thyroid Cancer: Clinical Picture of the Last Two Decades at a Single Oncology Referral Centre and Novel Therapeutic Options. Cancers, 2019. 11(8): p. 1188.
[4]	Mazzaferri, E.L. and S.M. Jhiang, Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med, 1994. 97(5): p. 418-28.
[5]	Brierley, J. and E. Sherman, The Role of External Beam Radiation and Targeted Therapy in Thyroid Cancer. Seminars in Radiation Oncology, 2012. 22(3): p. 254-262.
[6]	Venkatesh, Y.S., et al., Anaplastic carcinoma of the thyroid. A clinicopathologic study of 121 cases. Cancer, 1990. 66(2): p. 321-30.
[7]	Molinaro, E., et al., Anaplastic thyroid carcinoma: from clinicopathology to genetics and advanced therapies. Nat Rev Endocrinol, 2017. 13(11): p. 644-660.
[8]	Ganguly, R., S. Mitra, and A. Datta, Synchronous occurrence of anaplastic, follicular and papillary carcinomas with follicular adenoma in thyroid gland. Indian Journal of Pathology and Microbiology, 2010. 53(2): p. 337-339.
[9]	Wiseman, S.M., et al., Anaplastic Thyroid Cancer Evolved From Papillary Carcinoma: Demonstration of Anaplastic Transformation by Means of the Inter–Simple Sequence Repeat Polymerase Chain Reaction. Archives of Otolaryngology–Head & Neck Surgery, 2003. 129(1): p. 96-100.
[10]	Ricarte-Filho, J.C., et al., Mutational profile of advanced primary and metastatic radioactive iodine-refractory thyroid cancers reveals distinct pathogenetic roles for BRAF, PIK3CA, and AKT1. Cancer research, 2009. 69(11): p. 4885-4893.
[11]	Cabanillas, M.E., et al., Anaplastic Thyroid Carcinoma: Treatment in the Age of Molecular Targeted Therapy. Journal of Oncology Practice, 2016. 12(6): p. 511-518.
[12]	Haugen, B.R., et al., 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016. 26(1): p. 1-133.
[13]	Weitzman, S.P. and S.I. Sherman, Novel Drug Treatments of Progressive Radioiodine-Refractory Differentiated Thyroid Cancer. Endocrinol Metab Clin North Am, 2019. 48(1): p. 253-268.
[14]	Subbiah, V., et al., Dabrafenib and Trametinib Treatment in Patients With Locally Advanced or Metastatic BRAF V600–Mutant Anaplastic Thyroid Cancer. Journal of Clinical Oncology, 2018. 36(1): p. 7-13.