ANAPLASTIC THYROID CANCER: A CASE SERIES WITH A WIDE SPECTRUM OF TREATMENT IN EMERGENCY

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Domenico Michele Modica, Francesco Cupido, Giorgio Santamaria, Daniele Domenico De Bella, Donatella Marchese, Riccardo Speciale, Salvatore Gallina, Geraci Girolamo

Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies of the neck, and for the majority of these patients the cause of death is a compromised airway, metastatic disease, superior vena cava syndrome, asphyxiation, or exsanguination. In case of the airway being compromised, emergency treatment is mandatory but not well defined. We report 4 different kinds of acute presentation of complications.  Anaplastic thyroid cancer; diagnostic, clinical and prognostic indication, evaluation of choice of treatment are discussed. The spectrum of treatment varies from observation and preservation of the airway from a tracheostomy to extensive surgery. When a potentially curative resection is not feasible, the major challenge for the surgeons is the management of airway due to tracheal compression, unilateral or bilateral vocal cord paralysis and direct infiltration of the tumor in the tracheal lumen. Tracheostomy is indicated only in cases of insufficient respiratory glottic space and has the possible purpose of avoiding urgent tracheostomy. In cases of respiratory failure, after urgent tracheostomy it is also useful to perform a thyroid biopsy to make a diagnosis. PEG positioning is always indicated for the purpose of better nutrition in dysphagia patients. Any further surgical therapy, in cases of non-urgency and with a confirmed diagnosis, is, in our opinion, contraindicated due to the poor prognosis of the neoplasm.

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