NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001.

Cover of Surgical Treatment

Surgical Treatment: Evidence-Based and Problem-Oriented.

Show details

Thyroid carcinosarcoma and undifferentiated thyroid carcinoma

and .

Department of surgery, UCSF/Mount Zion Medical Center, San Francisco, U.S.A.

Carcinosarcoma

Carcinosarcoma of the thyroid gland is a rare but aggressive tumor. It arises from both the epithelial (carcinoma) and stromal (sarcoma) elements of the thyroid. Most cases occur in women who are older than years of age (1) and usually present with a rapid growing thyroid mass. Some patients may have had a history of multimodular goiter. The exact pathogenesis is unknown. Fine Needle Aspiration Biopsy (FNAB) will demonstrate malignant cells: spindle and mesenchymal cells. Recently we have collected 17 patients from the literature (Table 1). Treatment with total thyroidectomy and lymph node dissection is the only known effective treatment. Radiotherapy and chemotherapy are recommended because of the aggressive nature of this tumor. To date, no definite protocols are established for these patients.

Table I. Carcinosarcoma of the thyroid: summary of reported cases.

Table I

Carcinosarcoma of the thyroid: summary of reported cases.

Anaplastic Carcinoma

Anaplastic thyroid carcinoma is a rare and very aggressive tumor. It represents 5–10% of all thyroid carcinoma (2) and is more common in female than male patients (3.5/1). Patients usually present at about 60 years of age with a neck mass, dysphragia or change in voice or dyspnea. Multimodalities treatment are needed to treat these patients. Total thyroidectomy should be used whenever feasible followed by radiotherapy and chemotherapy. Some retrospective studies recently showed no difference in survival between patients who received surgery and those who did not. Most of these patients died from their disease. Chemotherapy is occasionally helpful but long term benefits are rare. Several modalities have been used. Some data suggest that paclitaxed may be helpful (3.6). High dose chemotherapy and hyperfractionation and radiotherapy after surgery improved survival in a recent retrospective study (5).

One randomized study compared doxorubicin with doxorubicin and cisplatin in 39 patients; a higher response to combined chemotherapy was demonstrated. Further studies and mulcentric trials should be initiated to find better ways to dignose an treat these patients.

Lymphoma of the Thyroid Gland

Prymary thyroid lymphoma is a rare disease. Most thyroid lymphomas are non-Hodgkin's of B-cell origin (7,8). There is a strong association between Hashimoto's Thyroiditis and lymphoma of the thyroid gland. The majority of these patients present with a neck mass; they are usually euthyroid.

Diagnosis and treatment

FNAB can usually distinguish between lymphoma and anaplastic carcinoma. Sometimes it is very difficult, however, to differentiate lymphoma from Hashimoto's thyroiditis. Immunohistochemical staining and flow cytometry, can help in the diagnosis of the lymphoma. After the diagnosis is established all patients should be staged. These tumors sre chemosensitive and radiosensitive and because they usually extend outside the thyroid gland, surgical resection alone is rarely curative. Thus radiotherapy chemotherapy is the prefered therapy. Different protocols have been used, including CHOP (Cyclophom, Sphamide, Adramycin, Vincristine, Prednisolone) (11,12).

Immature teratoma of Thyroid gland

This is a rare tumor. We have collected 14 cases in the English language literatures (9). Most teratomas in childhood are benign whereas teratomas in adults are usually malignant. These are aggressive tumors needing multimodality therapies. Total thyroidectomy followed by chemotherapy and radiotherapy is recommended. We have used 3 cycles of cisplatinum and VP-16 (9) for our patients. Most patients died of local recurrence or distant metastases.

References

1.
Al-Sobhi S, Novosolov F, Sabanci U, Epstein H D, Greenspan F S, Clark O H. Management of Thyroid Carcinosarcoma. Surgery. (1997);122:548–552. [PubMed: 9308612]
2.
Tan R K, Finley R K, Driscoll D. et al. Anaplastic carcinoma of the thyroid: A 24 year experience. Head & Neck. (1995);17:41–47. [PubMed: 7883548]
3.
Ain K B. Anaplastic thyroid carcinoma: Behavior, biology and therapeutic approaches. Thyroid. (1998);8:715–726. [PubMed: 9737368]
4.
Lu T, Lin J D, Huang H S, Chao T C. Does surgery improve the survival of patients with advanced anaplastic thyroid carcinoma? Oto HNS. (1998);118:728–731. [PubMed: 9591882]
5.
Kobaysashi T, Asakawa H, Umeshita K. Treatment of 37 patients with anaplastic carcinoma of the thyroid. Head and Neck. (1996);18:36–41. [PubMed: 8774920]
6.
Ain K B, Tofig S, Tylow K D. Antineoplastic activity of taxol against human anaplastic thyroid carcinoma cell lines in vitro. JCEM. (1996);18:650–653. [PubMed: 8855817]
7.
Compagno J, Oertel J E. Malignant lymphoma and other lymphoproliferative disorders of the thyroid gland: A clinicopathological study of 245 cases. Am J Clinic Pathology. (1980);74:1–11. [PubMed: 7395811]
8.
Kapadia S B, Dekker A, Cheng V S. et al. Malignant lymphoma of the thyroid gland. A clinicopathologic study. Head Neck Surgery. (1982);4:270–280. [PubMed: 7045044]
9.
Al-Sobhi S, Bazarbashi S, Al-Jiffry B. et al. Immature teratoma of the thyroid gland: A Case report and review of the literatures. Annals of Saudi Medicine. (1998);18:254–256. [PubMed: 17341980]
10.
Doria R, Jekel J F, Cooper D L. Thyroid Lymphoma. The case for combined modality. Therapy Cancer. (1994);73:200–6. [PubMed: 8275426]
11.
Matsuzuka F, Miyauchi A, Katayama S. et al. Clinical aspects of primary thyroid lymphoma: Diagnosis and treatment based on our experience of 199 cases. Thyroid. (1993);3:93–99. [PubMed: 8369658]
12.
Butler J S Jr, Brady L W, Amendola B E. Lymphoma of the thyroid. Am J Clin Oncology. (1990);13:64–69. [PubMed: 2407105]
13.
Saltykow S. Über das gleichzeitige Vorkommen des Sarkom und des Carcinomas in der Schilddrüse. Zentralbl Allg Pathol. (1905);12:561–570.
14.
Chavannaz G, Nadal P. Tumeur mixte maligne du corps thyroide. J Med Bordeaux. (1910);11:817–820.
15.
Zeckwer I T. Fibrosarcoma of the thyroid. Arch Surg. (1926);12:561–570.
16.
Arons I. Sarcoma of the thyroid gland. Ann Surg. (1930);91:44–56. [PMC free article: PMC1398100] [PubMed: 17866248]
17.
Nimpfer Ein ungewöhnlicher Schilddrüsentumor. Zentralbl Allg Pathol. (1931);53:137.
18.
Pinston M (1958) Le sarcome squelettogene du corps thyroide. Thesis, Lyon, France .
19.
Cabanne F, Piaget F, Couder P. et al. Carcino-sarcome osteogenique du corps thyroide chez une malade de 60 ans. Arch Anat Cytol Pathol. (1964);12:280–283. [PubMed: 14311568]
20.
Arean V M, Schildeckker W W. Carcinosarcoma of the thyroid gland: report of two cases. South Med J. (1964);57:446–451. [PubMed: 14139846]
21.
Lira V, Maranhao E. Malignant mixed tumor of thyroid gland. J Pathol. (1965);80:377–379. [PubMed: 14263485]
22.
Hedinger CE (1969) Thyroid cancer. Springer, New York, pp 47–52 .
23.
Heitz P, Moser H, Staub J J. A study of 573 thyroid tumors and 161 autopsy cases observed over a 30-year period. Cancer. (1976);37:2329–2337. [PubMed: 1260718]
24.
Donnell C A, Pollock W J, Sybers W A. Thyroid carcinosarcoma. Arch Pathol Lab Med. (1987);111:1169–1172. [PubMed: 3314789]
25.
Cooper K, Barker E M. Thyroid carcinosarcoma: a case report. S Afr J Surg. (1989);27:192–193. [PubMed: 2609238]
26.
Grillo HC, Suen HC, Mathiesen DJ, Wain JC (1992) Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg 54: 39; discussion 9–10 . [PubMed: 1610250]
Copyright © 2001, W. Zuckschwerdt Verlag GmbH.
Bookshelf ID: NBK6956

Views

  • PubReader
  • Print View
  • Cite this Page

Related information

  • PMC
    PubMed Central citations
  • PubMed
    Links to PubMed

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...