eMedicine Specialties > Oncology > Carcinomas of Endocrine Organs

Thyroid, Anaplastic Carcinoma: Differential Diagnoses & Workup

Author: Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Brigham and Women's Hospital, Harvard University
Coauthor(s): Debra J Graham, MD, Director of Surgical Specialties Service, Cleveland Louis Stokes VA Medical Center, Associate Program Director, Assistant Professor, Department of Surgery, Case Western Reserve University
Contributor Information and Disclosures

Updated: Apr 18, 2006

Differential Diagnoses

Goiter
Thyroid, Follicular Carcinoma
Hyperthyroidism
Thyroid, Medullary Carcinoma
Hypothyroidism
Thyroid, Papillary Carcinoma
Parathyroid Carcinoma
Thyroiditis, Subacute
Thyroid Lymphoma
Thyroid Nodule

Other Problems to Be Considered

Thyroid, adenoma

Workup

Laboratory Studies

  • Anaplastic thyroid carcinoma (ATC) cannot be definitively diagnosed with laboratory examinations of the blood or urine.
  • Obtain serum calcium levels to rule out medullary thyroid carcinoma or parathyroid neoplasms.

Imaging Studies

  • Chest radiography may be used to determine the presence of lung metastases.
  • Preoperative cervical ultrasonography can detect lymph node metastases.
  • Cervical CT scanning can be used to define the local spread of disease. Detection of distant metastases to the mediastinum, liver, lung, bone, and brain is also possible via CT scanning or MRI.
  • Bone scanning can be used to determine the presence of bone metastases.

Procedures

  • Fine-needle aspiration often yields enough cytologic information to allow diagnosis; however, if fine-needle aspiration is inadequate, patients may require an open surgical biopsy.

Histologic Findings

Grossly, ATC is described as a large, fleshy, off-white tumor. Infiltration of adjacent structures can be observed grossly and microscopically. Histologically, observation of regions of spontaneous necrosis and hemorrhage may be observed. Typically, angioinvasion is detectable.

The main histologic variants include spindle cell, giant cell (osteoclastlike), squamoid, and paucicellular. The giant cell subtype typically exhibits local calcification with significant osteoid formation. The paucicellular subtype demonstrates rapid growth, intense fibrosis, focal infarction, diffuse calcification, and encroachment of adjacent vascular tissue by atypical spindle cells.

Thyroid lymphoma is the only curable condition that may be confused with ATC. Rule out lymphoma in the presence of a poorly differentiated large cell thyroid tumor. This investigation involves lymphoid tissue markers (eg, cytoplasmic immunoglobulin, immunoglobulin receptors, gene rearrangement studies).

More on Thyroid, Anaplastic Carcinoma

Overview: Thyroid, Anaplastic Carcinoma
Differential Diagnoses & Workup: Thyroid, Anaplastic Carcinoma
Treatment & Medication: Thyroid, Anaplastic Carcinoma
Follow-up: Thyroid, Anaplastic Carcinoma
References
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References

  1. Ain KB. Anaplastic thyroid carcinoma: a therapeutic challenge. Semin Surg Oncol. 1999;16:64-69. [Medline].

  2. Austin JR, el-Naggar AK, Goepfert H. Thyroid cancers. II. Medullary, anaplastic, lymphoma, sarcoma, squamous cell. Otolaryngol Clin North Am. 1996;29:611-27. [Medline].

  3. Goutsouliak V, Hay JH. Anaplastic thyroid cancer in British Columbia 1985-1999: a population-based study. Clin Oncol (R Coll Radiol). Apr 2005;17(2):75-8. [Medline].

  4. Kapp DS, LiVolsi VA, Sanders MM. Anaplastic carcinoma following well-differentiated thyroid cancer: etiological considerations. Yale J Biol Med. 1982;55:521-8.

  5. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer. Apr 1 2005;103(7):1330-5. [Medline].

  6. Schott M, Scherbaum WA. Immunotherapy and gene therapy of thyroid cancer. Minerva Endocrinol. Dec 2004;29(4):175-87. [Medline].

  7. Udelsman R, Lakatos E, Ladenson P. Optimal surgery for papillary thyroid carcinoma. World J Surg. 1996;20:88-93. [Medline].

  8. Xing M. BRAF mutation in thyroid cancer. Endocr Relat Cancer. Jun 2005;12(2):245-62. [Medline].

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Further Reading

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Keywords

undifferentiated thyroid carcinoma, anaplastic carcinoma of the thyroid, anaplastic thyroid carcinoma, ATC, thyroid gland malignancy, anaplastic thyroid carcinoma, thyroid cancer, thyroid tumor, metastases, thyroid malignancy

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Contributor Information and Disclosures

Author

Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Brigham and Women's Hospital, Harvard University
Disclosure: Nothing to disclose.

Coauthor(s)

Debra J Graham, MD, Director of Surgical Specialties Service, Cleveland Louis Stokes VA Medical Center, Associate Program Director, Assistant Professor, Department of Surgery, Case Western Reserve University
Debra J Graham, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, Association for Academic Surgery, Association of VA Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

John S Macdonald, MD, Professor of Medicine, New York Medical College; Chief, Division of Medical Oncology, St Vincent's Hospital and Medical Center; Medical Director, Saint Vincent's Comprehensive Cancer Center
Disclosure: Nothing to disclose.

 
 
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