Metastatic squamous cell carcinoma thyroid from functionally cured cancer cervix
A 68-year-old female patient presented with swelling in the left side of the neck of 6 weeks duration progressively increasing in size and not associated with any pain, difficulty in swallowing or alteration of speech. The swelling was located in the lateral aspect of neck, lobulated and appeared lymph nodal in origin. There was also an associated nodular swelling of the left lobe thyroid. Ultrasonography of neck revealed multiple necrotic cervical lymph nodes on the left side and multiple hypo echoic nodules in the left lobe associated with thyroid enlargement. Positron emission tomography/computed tomography (PET/CT) revealed hyper metabolic multiple level left cervical lymph nodes with necrosis and hypermetabolic large hypo dense nodule with specks of calcification in the left lobe thyroid, few small hypo dense nodules were also seen in the right lobe as well []. Fine needle aspiration cytology from the cervical node and thyroid revealed keratinizing squamous cell carcinoma. Detailed clinical history of the patient revealed previous histopathological evidence of squamous cell carcinoma cervix that had occurred 12 years ago and treated with hysterectomy followed by post-operative radiation to pelvis. Patient underwent total thyroidectomy and radical neck dissection on the left side of the neck. Histopathology revealed thyroid follicles with adjacent tumor tissue composed of polygonal cells with vesicular pleomorphic nuclei, prominent nucleoli and a moderate amount of eosinophilic cytoplasm arranged in sheets with focal keratin pearl formation suggestive of squamous carcinma amidst thyroid follicles []. The thyroid specimen was subjected to real time polymerase chain reaction study for any presence of high risk human papilloma virus signature, which is not detectable patient was given post-operative radiotherapy to neck along with concurrent chemotherapy with weekly cisplatin. Interim PET/CT after 6 weeks surprisingly revealed extensive disease with the multiple metabolically active lung, liver and bone metastasis []. Patient was restaged with progression of disease and management changed from curative to palliative intent.