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Michigan Oncology Journal Fall 97

The Evan Shapiro Case Study: Primary Squamous Cell Carcinoma of the Thyroid

-June Chan, M.D.

The following case study is made possible by the Evan Shapiro Memorial Fund, commemorating the life of a gifted and talented young man who was stricken with Ewing’s sarcoma while in high school. It is with deep appreciation that the U-M Cancer Center thanks those who have made this on-going series possible in Evan’s memory.

Presentation of Case
J.G. is a 31-year-old woman who presented with right ear pain and an anterior neck mass associated with dysphagia after delivering her fourth child. She denied any symptoms of dyspnea, neck pain or voice changes. A fine needle aspiration was positive for poorly differentiated carcinoma. She underwent a right thyroid lobectomy/isthmusectomy that revealed infiltrating squamous cell carcinoma with positive margins and an involved right paratracheal lymph node. A triple endoscopy to rule out other sources of squamous cell carcinoma was negative. CT imaging of the neck post-operatively showed a soft tissue mass measuring 3 cm x 3 cm x 4 cm located in the right thyroid bed without lymphadenopathy. Chest CT and bone scan were both negative. J.G. was treated with 3D post-operative radiation therapy to a total dose of 65 Gy to the tumor bed and bilateral neck. She returned for follow-up one month after completion of radiation and although her acute radiation toxicity (oral mucositis) had improved, she continued to experience ear pain. Clinical exam noted palpable left neck lymphadenopathy. A CT scan at that time showed ring-enhancing lesions throughout the nodal chains consistent with metastatic involvement, as well as evidence of recurrence in the local tumor bed. A biopsy confirmed squamous cell carcinoma. It was felt that an extensive bilateral neck dissection with pharyngectomy would be necessary for any chance of local control. After considering her options given her poor prognosis, she opted to enter an experimental immunotherapy protocol.

Primary Squamous Cell Carcinoma of the Thyroid
Primary squamous cell carcinoma (SCC) of the thyroid gland is an extremely rare malignancy, with only about 50 cases in the world-wide literature. Usually, SCC involving the thyroid gland results because of direct extension from the adjacent larynx, trachea or esophagus. SCC arising directly from the thyroid tends to affect older patients (5th to 6th decade), that have a long-standing history of goiter. Its etiology is not definitely known, but hypotheses include the “metaplasia theory” (squamous metaplasia of underlying thyroid disease) and “embryonic-rest theory” (squamous cells originating from remnant ultimobranchial duct or thyroglossal duct). Patients present with sudden increase in size of a chronic neck mass, with or without cervical adenopathy. Other symptoms include dysphagia, dyspnea and hoarseness secondary to infiltration of adjacent structures. At the time of diagnosis, these tumors are usually locally advanced with invasion into the trachea, esophagus and major vessels. If possible, surgical resection should be attempted, followed by adjuvant radiation therapy (doses in the literature range from 40 to 55 Gy). Although SCC of the thyroid is felt to be radioresistant and unresponsive to chemotherapy, there have been a few cases where complete excision and post-operative radiation have been curative. Overall however, this disease has a poor prognosis with a median survival of <6 months in the majority of cases. Death is usually secondary to progression of local disease although some cases have distant metastases at autopsy.

References

  1. Goldman R. Primary squamous cell carcinoma ofthe thyroid gland: report of a case and review of the literature. American Surgeon. 30(4): 247-251, 1964.
  2. Misonou J et al. Pure squamous cell carcinoma of the thyroid gland - report of an autopsy case and review of the literature. Japanese Journal of Surgery.
    18(4): 459-474, 1988.
  3. Sarda AK et al. Squamous cell carcinoma of the thyroid. J Surg Onc. 39:175-78, 1988.
  4. Simpson WJ. Squamous cell carcinoma of the thyroid gland. Amer J Surg. 156:44-46, 1988.
  5. Tsau-Yuen Huang et al. Primary squamous cell carcinoma of the thyroid gland: a report of four cases. Amer J Clin P55:93-98, 1971.ath.

June Chan, M.D., is a resident in the department of Radiation Oncology.

Editor’s Note: The Evan Shapiro case study on Stevens-Johnson syndrome, which was presented in the summer 1997 issue, was authored by Getha Rao, M.D., of the department of Radiation Oncology

 

 

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Please note: The articles listed in the Cancer Center's News Archive are here for historical purposes. The information and links may no longer be up-to-date.