A rare case of multinodular goitre turning in to anaplastic carcinoma

Abstract

Thyroid diseases are commonly seen in patients attending surgical outpatient department. It includes hyperthyroidism, hypothyroidism, thyroiditis, goiter and neoplasms. Thyroid enlargement is the most common sign, and multinodular goiter is the most common disease leading to the enlargement of thyroid. Although benign tumors are more common than malignant, primary thyroid carcinomas are not uncommon. Among the different primary carcinomas, anaplastic carcinoma stands out as the least frequent and the most aggressive. In fact, anaplastic thyroid carcinoma is one of the most aggressive and ultimately fatal malignancies known. Essentially there are no long-term survivals, and most patients die within months from the time of diagnosis. Clinically, they present with a rapidly enlarging mass and consequent upper aero digestive obstructive symptoms. Actually, 15-50% of patients presenting with anaplastic thyroid carcinoma have extensive local invasion and distant metastasis at the time of diagnosis. Of these, up to 90% will have lung and pleural metastasis. The diagnosis of anaplastic thyroid carcinoma can be achieved utilizing fine needle aspiration. However, the presence of preexisting thyroid disease may complicate the issue and make the diagnosis more challenging. Anaplastic thyroid carcinoma arising in multinodular goitre is very rare. We report a rare case where the patient had a long-standing history of multinodular goitre which turned in to anaplastic thyroid carcinoma. The cytopathologic features and the relationship between anaplastic thyroid carcinoma, pre-existing multinodular goiter are discussed.