anterior cervical mass - mme conferences
TRANSCRIPT
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Anterior Cervical Mass
Prof. Suhail Al-Salam, MBChB, FRCPath
Department of Pathology, CMHS, UAEU
Consultant Pathologist, Tawam Hospital
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A 67-year-old patient with type 2 diabetes
Lower anterior neck mass of 10 cm diameter
4 months duration,
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Past Medical History 2014: diagnosed with well differentiated papillary
thyroid carcinoma which was treated with subtotal
thyroidectomy followed by Radioactive I 131 100 Mci,
post treatment follow up thyroid scan was negative
for residual or metastatic disease.
2016: patient had recurrent thyroid tumor and he
underwent for re-surgery and therapeutic dose 30
Mci of radioactive I 131.
March 2017 patient underwent 3rd surgery due to
recurrent disease, and was considered as radioactive
Iodine refractory thyroid carcinoma and started on
Sorafenib for 3 months completed on May 2017 but
clinically he was not responding as the tumor
increasing in size progressively.
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CT Head &Neck
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The mass was unresectable and biopsy
was taken,
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CYTOKERATIN EMA
VIMENTIN THYROGLOBULIN
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PAX8 TTF1
P63 KI67
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Differential Diagnosis
Recurrent Papillary carcinoma
Anaplastic Thyroid Carcinoma
Metastatic carcinoma
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Anaplastic Thyroid Carcinoma Undifferentiated carcinoma of thyroid gland
2% of thyroid cancers but 40% of thyroid cancer deaths
Rapidly enlarging, bulky neck mass invades adjacent
structures causing hoarseness, dysphagia, dyspnea
Three histologic patterns:
Large, pleomorphic giant cells resembling osteoclasts with
cellular connective tissue septa,
Spindle cells resembling sarcoma
Squamoid cells that are relatively undifferentiated but also
appear epithelial with occasional focal keratinization
(Am J Surg Pathol 1991;15:160)
(Int.J.Endocrinoloy 2014;790834:1-13)
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Pathogenesis
Anaplastic transformation of papillary,
follicular or Hürthle cell carcinoma,
Most cases have a core of conserved
mutations in well differentiated and
anaplastic areas, plus increases in
mutation rates in anaplastic areas
(Am J Surg Pathol 2003;27:1559)
Sugitani et al. has reported that almost
1% of PTC may progress to ATC
(World J Surg. 2012; 36(6):1247-54.)
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Signaling Pathways
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Molecular Changes Associated with aggressive
behavior and Anaplastic thyroid carcinoma
BRAF (V600E) mutation
TERT mutation
TP53 mutation
NRAS
KRAS
(J Oncol Pract. 2016 Jun;12(6):511-8)
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Conclusions
Papillary thyroid carcinoma can
progress to Anaplastic carcinoma
Cytokeratin, vimentin, PAX8, TTF1,
thyroglobulin and p63 are good primary
panel for solving the differential
diagnosis
A combined BRAF&TERT mutations in
a papillary carcinoma caries a high risk
of recurrence and anaplastic
transformation
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Thank you
Do you have
any question?