Undifferentiated (Anaplastic) Carcinoma of The Thyroid with Abundant Mucin Production
A Rare Presentation Causing Diagnostic Difficulty
Keywords:
Anaplastic carcinoma, Extracellular mucin, Mucinous carcinoma, Papillary carcinoma, Thyroid neoplasm
Abstract
Most pathologists are unaware that thyroid gland also produces mucin; often associated with typical thyroid carcinoma rather than primary mucinous neoplasm. We report an unusual case of anaplastic carcinoma of thyroid presenting with abundant extracellular mucin. A 65 year old lady presented with painless, neck swelling since 7-8 months. Thyroid function tests were within normal limits. Imaging suggested neoplastic aetiology of thyroid. Cytology revealed abundant extracellular mucin with occasional large atypical cells. Hence, metastasis followed by primary mucinous thyroid carcinoma was considered. After excluding secondary neoplasms, total thyroidectomy with lymphadenectomy was performed. Histopathology revealed an infiltrative tumour with abundant mucin & necrosis amidst fibrotic bands. Tumour cells were arranged in sheets, with features of anaplasia. Focus of papillary thyroid carcinoma also identified. Mucicarmine and Alcian blue special stains were positive. Immunohistochemistry results of positive cytokeratin and negative TTF1, thyroglobulin and calcitonin confirmed our results.References
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2. Antonio AD, Addesso M. Mucinous carcinoma of thyroid gland. Report of a primary and a metastatic mucinous tumour from ovarian adenocarcinoma with immunohistochemical study and review of literature. Virchows Arch. 2007;451:847–51.
3. Scopa CD. Histopathology of Thyroid Tumors. An Overview. Hormones. 2004;3(2):100–10.
4. Squillaci S, Pitino A, Spairani C, Ferrari M, Carlon E, Cosimi MF. Mucinous Variant of Follicular Carcinoma of the Thyroid Gland: Case Report and Review of the Literature. Int J Surg Pathol. 2016;24(2):170–6.
5. Matsuo M, Tuneyoshi M, Mine M. Primary mucinous carcinoma with rhabdoid cells of the thyroid gland: a case report. Diagn Pathol. 2016;11:1–5.
6. Wang J, Guli Q, Ming X-C, Zhou H-T, Cui Y-J, Jiang Y-F, et al. Primary mucinous carcinoma of thyroid gland with prominent signet-ring-cell differentiation : a case report and review of the literature. Onco Targets Ther. 2018;11:1521–8.
7. Uccella S, Rosa S La, Finzi G, Erba S, Sessa F. Mixed Mucus-Secreting and Oncocytic Carcinoma of the Thyroid. Arch Pathol Lab Med. 2000;124:1547–52.
8. Kim NR, Cho HY, Piña-oviedo S, Roza GD La, Lee YD, Ro JY. Follicular Adenoma with Extensive Extracellular Mucin Deposition: Report on Two Cases. Clin Med Insights Case Reports. 2012;5:155–62.
9. Parenti R, Salvatorelli L, Magro G. Anaplastic Thyroid Carcinoma : Current Treatments and Potential New Therapeutic Options with Emphasis on TfR1 / CD71. Int J Endocrinol. 2014;1–11.
Published
2019-12-24
Issue
Section
Case Report
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