|Year : 2020 | Volume
| Issue : 1 | Page : 39-41
Primary squamous cell carcinoma thyroid: A rare case
Nitin Khunteta, Shikha Tewari
Department of Surgical Oncology, Bhawan Mahaweer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
|Date of Submission||22-Nov-2017|
|Date of Acceptance||27-May-2018|
|Date of Web Publication||18-Jun-2020|
Department of Surgical Oncology, Bhawan Mahaweer Cancer Hospital and Research Centre, Jaipur - 302 017, Rajasthan
Source of Support: None, Conflict of Interest: None
Primary Squamous Cell Carcinoma of Thyroid gland is a very rare disease. It forms less than 1% of all Thyroid cancers. Due to rarity, It is generally diagnosis of exclusion.
Keywords: Cancer, squamous cell carcinoma, thyroid
|How to cite this article:|
Khunteta N, Tewari S. Primary squamous cell carcinoma thyroid: A rare case. J Head Neck Physicians Surg 2020;8:39-41
| Introduction|| |
The incidence of thyroid cancer in India is 0.3%. The histologies of thyroid cancer are well-differentiated thyroid cancer almost 80%, medullary carcinoma 10%, undifferentiated 1%, and other rare histologies <1% of the total. These histologies are lymphoma, sarcoma, and rarely squamous cell carcinoma (SCC). Due to rarity of primary SCC of the thyroid, it is a diagnosis of exclusion. Around 60 cases have been reported in literature. As per literature, search primary SCC of the thyroid is diagnosed at advanced stage and hence has dismal prognosis, poor survival outcome even on treatment. Early diagnosis is crucial for better outcome in primary SCC of the thyroid.
| Case Report|| |
A 75-year-old male presented with multiple comorbidities such as diabetes mellitus, hypertension, ischemic heart disease and asthma for the last 10–15 years, on treatment. He presented with chief complaints of swelling left side of lower neck for the last 10 years which started increasing in size for the last 1 year, along with that hoarseness of voice and dysphagia for the last few days.
On examination, performance status was Eastern Cooperative Oncology Group 1; on neck examination, there was a thyroid left lobe swelling measuring 8 cm × 10 cm, and it was extending retrosternally.
Rest of the examination was normal
Contrast-enhanced computed tomography of the neck revealed a mass replacing the left thyroid lobe, invading thyroid cartilage, compressing the glottis and trachea; the mass was extending in the tracheoesophageal groove, esophagus, and prevertebral fascia. The mass was encasing the carotid artery [Figure 1]. Blood biochemistry, thyroid profile, chest X-ray, and ultrasonography of the abdomen were within normal limits. Fine-needle aspiration cytology of the thyroid swelling showed poor cell content. Biopsy was SCC with immunohistochemical (IHC) profile positive for CK 7, CK 5/6, and EMA but negative for CK-20, thyroid transcription factor 1 (TTF-1), thyroglobulin, and P40. Positron emission tomography–computed tomography (PET-CT) scan showed hypermetabolic bilateral nasopharynx thickening with standard uptake value (SUV) of 10.37 and a left thyroid nodule with SUV of 5.16 [Figure 2]. Upper gastrointestinal scopy and nasopharyngoscopy were normal. Biopsy taken from nasopharynx showed severe inflammation without any evidence of malignancy. The patient was diagnosed as primary SCC of thyroid, stage T4b N0 M0. The patient was treated with concurrent chemo-radiation protocol.
|Figure 1: Computed tomography scan of squamous cell carcinoma of the thyroid|
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|Figure 2: Positron emission tomography–computed tomography scan of squamous cell carcinoma of thyroid|
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| Discussion|| |
Primary SCC of the thyroid is a very rare entity, and it affects older population in the fifth and sixth decades of life, with a mean age of 63 years and with a 2:1 female to male ratio.
Diagnostic workup SCC of the thyroid is typically through fine-needle aspiration; PET-CT is necessary to differentiate primary from metastatic carcinoma. IHC of SCC demonstrates positive staining for p53, p63, cytokeratins 7–19, and SCC antigen, in addition to negative staining for TTF and calcitonin.,,
Etiology of SCC of the thyroid remains uncertain, and three theories have been postulated. The embryonic nest theory suggests that embryologic remnants, such as thyroglossal duct, give rise to epithelial cells, while the de-differentiation theory suggests that existing thyroid carcinoma of papillary, follicular, or medullary histology de-differentiates into SCC. Another theory called the metaplasia theory hypothesizes that local inflammatory condition, such as Hashimoto's thyroiditis, results in squamous metaplasia. In the present case, the patient has had long history of thyroid swelling, and de-differentiation theory is more likely.
Mean survival time for patients with SCC of the thyroid is 9 months, with a 20% 3-year survival rate. In comparison, the mean survival rate of patients with metastatic papillary carcinoma, is significantly higher at 76.6%. There is currently no standard of care for the treatment for primary SCC.
Due to the aggressive nature of the disease, total thyroidectomy alone has led to minimal survival time., Some series have reported better outcome with multimodality treatment, surgery, and postoperative radiotherapy, with reported survival up to 31 months., However, no prospective trials have directly compared longevity using combination therapy versus thyroidectomy alone. In the present case, the patient was unresectable and underwent chemoradiotherapy.
| Conclusion|| |
Primary SCC of the thyroid gland is a diagnosis of exclusion. It is a very rare disease <1% of all primary carcinoma of the thyroid gland. It is an aggressive and fatal disease. Treatment should be multimodal. More reports of this rare malignancy will continue to develop our understanding of the etiology, diagnosis, and treatment of this disease.
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Conflicts of interest
There are no conflicts of interest.
This material has never been published and is not currently under evaluation in any other peer reviewed publication.
The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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