Anaplastic thyroid carcinoma arising in long-standing multinodular goiter following radioactive iodine therapy: report of a case diagnosed by fine needle aspiration.
BACKGROUND
Anaplastic thyroid carcinoma (ATC) is a highly aggressive, undifferentiated carcinoma that may arise on top of normal or abnormal thyroid. Making the diagnosis by fine needle aspiration (FNA) of the thyroid with a long-standing history of multinodular goiter (MNG) is not uncommon. We report a case discussing the cytopathologic findings and the relationship with long-standing goiter and thyroid exposure to radioactive iodine treatment.


METHODS
A 90-year-old male patient presented with a > 45-year history of MNG that was associated with thyrotoxicosis and multiple courses of radioiodine (I-131) treatment. He developed recent symptoms of dyspnea, dysphagia, neck welling and uniintentional weight loss. Computed tomography of the neck was done revealing a large MNG with retrosternal extension and calcifications. FNA was performed revealing highly anaplastic cells with a colloid background and presence of neutrophils. The diagnosis of ATC was made. The patient refused any kind of management and was discharged upon his request. He died 2 days after the procedure, and no autopsy was performed.


CONCLUSIONS
ATC is an aggressive, undifferentiated thyroid carcinoma that can be diagnosed by FNA and save the patient a surgical intervention. A background of MNG and history of radioactive iodine therapy is not uncommon.
Maatouk
Jamal
J
Department of Medicine, James H. Quillen Veterans Affairs Medical Center, Mountain Home (Johnson City), Tennessee 37684, USA.
Barklow
Thomas A
TA
Zakaria
Wael
W
Al-Abbadi
Mousa A
MA
D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000209:etiology / Q000473:pathology*; D017809:Fatal Outcome; D006044:Goiter, Nodular / Q000150:complications*; D006801:Humans; D007150:Immunohistochemistry; D007457:Iodine Radioisotopes / Q000009:adverse effects*; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000473:pathology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000209:etiology / Q000473:pathology*; D013971:Thyrotoxicosis / Q000209:etiology / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed; D016312:Treatment Refusal
D007457:Iodine Radioisotopes