Palliative Radiation in Primary Squamous Cell Carcinoma of Thyroid: A Rare Case Report
A 70-year-old male patient noticed a rapidly increasing painless mass at the anterior aspect of the left side of neck for 1 month. It was also associated with dysphagia and stridor for 2 weeks. He was a heavy smoker who used to smoke 1 pack of cigarettes/day. There was no history of any previous radiation exposure in the neck. On physical examination, an 11 cm × 7 cm firm lobulated mass was found in the left side of the anterior aspect of the neck. His routine blood investigations and chest X-ray were within the normal limit.\nContrast enhanced computed tomography scan showed evidence of well-defined large, lobulated heterogeneously enhancing solid cystic lesion measuring 11 cm × 8.6 cm × 7.4 cm in relation to the left lobe of thyroid gland. The lesion showed multiple thin intervening septae along with few specks of calcification within it. Posteriorly lesion was extending up to the vertebral column and inferiorly retrosternally up to the brachiocephalic trunk. Mass effect of the lesion was seen in the form of compression and displacement of the trachea toward right and there was also compression and displacement of the left subclavian and carotid vessels, left internal jugular vein and left sternocleidomastoid []. His endoscopy findings were within the normal limit. On positron emission tomography scan, a large multi lobulated heterogeneously enhancing solid-cystic mass (7.8 cm × 7.7 cm × 5.8 cm) was seen in the left side of the neck arising from the left lobe of the thyroid gland with intense fluorodeoxyglucose (FDG) avidity (standardized uptake value max 17.7) in the solid component and along the peripheral margin of the cystic component. The mass was extending into the anterior mediastinum until the level of D4 vertebra and posteriorly until the prevertebral fascia. It was seen to displace the trachea to the right and compressing it []. No FDG avid focus was found in any other part of the body.\nFine-needle aspiration cytology (FNAC) revealed scattered malignant epithelial cells which showed moderate pleomorphism, high nuclear cytoplasmic ratio, hyperchromatic nuclei and mild to moderate cytoplasm. Large areas of necrosis were also seen. The overall features were those of SCC [ and ].\nAggressive treatment in the form of radical surgery was not possible in this particular patient because of its unresectability due to encasement of major vessels. Hence, we delivered palliative radiotherapy 30 Gy in 10 fractions over 2 week's period. Though there was not much regression of the disease, but his pain and shortness of breath was improved reasonably and patient is leading a good quality-of-life for last 1 year.