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

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