A case of concurrent several forms of thyroid cancer
A 40-year-old man presented to medical clinic with right neck mass appeared 2-3 months before. He had not any significant findings in his past medical history except functional colitis. He had not history of smoking, drinking, or drug abusing. He neither had exposure to radiation. He had been working in a shoes workshop without any known risk factors for thyroid cancer. Family history revealed the presence of brain tumor in his cousin. Physical examination showed the absence of lymphadenopathy, organomegaly, or skin changes. The only finding was a round firm painless mass with 2.5-cm diameter at posterior triangle in right side of the neck.\nBlood tests showed normal CBC (with differentiation), FBS, renal, hepatic and thyroid functional tests, U/A, coagulation tests, and CEA, with minimally increased alpha-feto-protein. Thyroid ultrasonography with superficial 7.5-MHz probe was normal. Spiral CT-scan of lungs, abdomen, and pelvis was normal without metastatic lesion. Spiral CT-scan of neck showed a 42 × 37 × 31 mm solid tumor with peripheral calcification in right side posterior triangle behind the SCM muscle, with anteromedial replacement of carotid artery. FNA of the mass revealed PTC.\nRight thyroid lobectomy was performed with right neck lymphadenectomy from level II-V. Early pathologic survey showed normal tissue with mild chronic inflammation for thyroid right lobe, and follicular variant of papillary carcinoma with diffuse areas for resected mass at posterior triangle in right side of the neck [Figures and ].\nConsultation to another expert pathologist revealed the presence of an occult focal area of papillary carcinoma in right thyroid lobe with metastasis to right posterior cervical lymph node, in which papillary and follicular variant transformed to anaplastic cancer [Figures and ].\nThe patient underwent adjuvant radiotherapy with Cobalt 60 THR machine. This therapy continued for five sessions in every week at level I-V and right supraclavicular and infraclavicular region with the dosage of 4500 CG in combination with 30-mg adriamycine. Then, by exclusion of spinal cord, the radiotherapy as boost dosage of 2600 CG was continued at level III-V and right supraclavicular and infraclavicular region without chemotherapy. He is alive and healthy after 4 years. His left thyroid lobe is intact and is being followed-up regularly. Until now, no recurrence is detected.