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Abstract: The patient unintentionally discovered a neck mass 1 month ago, which recently grew rapidly and presented with difficulty in breathing and swallowing as well as hoarseness, and was seen in our outpatient clinic. Thyroid puncture was performed under ultrasound guidance, and the pathological findings confirmed undifferentiated carcinoma of the thyroid gland. After multidisciplinary consultation, the patient underwent surgery, and the lesion and the invaded trachea were completely removed, and there was no recurrence in the postoperative review 1 year later.
Basic information】Female, 47 years old
Type of disease】Undifferentiated thyroid cancer
Hospital】The First Hospital of Harbin Medical University
Date of consultation】November 2020
Treatment plan】Surgical treatment (total thyroidectomy, central lymph node dissection, tracheal sleeve resection)
Treatment period】Inpatient treatment for 10 days, outpatient review after 1 month
Treatment effect] The lesion and the trachea it invaded were completely removed, and no recurrence was seen in the postoperative review 1 year later.
I. Initial consultation
The patient, a 47-year-old female, unintentionally discovered a bean-sized swelling on her neck one month ago, which recently grew rapidly and presented with difficulty in breathing, swallowing and hoarseness. Two egg-sized masses were palpable in the patient’s neck bilaterally. Ultrasound examination of the thyroid gland showed a 4.4×2.8×3.9 cm hypoechoic nodule with clear borders and regular contours, uneven internal echogenicity, and no echogenicity in the neck, and a rich blood flow signal in the ultrasound. The internal echogenicity was not homogeneous, and a little echogenicity and a lot of streak-like echogenicity were seen. After full communication with the patient, ultrasound-guided thyroid aspiration was performed, and the pathological diagnosis was confirmed as undifferentiated thyroid cancer.
II. Treatment history
Since the patient had already undergone thyroid nodule puncture and the pathological diagnosis was confirmed as undifferentiated thyroid carcinoma, and the patient and her family had a strong desire for treatment, surgery was considered for her. After the patient was hospitalized and the necessary examinations such as thyroid CT examination and fiberoptic bronchoscopy and laryngoscopy were completed, it was found that the lesion had invaded part of the trachea. After multidisciplinary consultation and thorough communication with the patient and his family, he underwent total thyroidectomy, lymph node dissection in the central region and tracheal sleeve resection with an indwelling tracheal tube for breathing. The patient still needed postoperative radiotherapy and targeted therapy. After 10 days of hospitalization, the patient was discharged in stable condition and was instructed to review outpatient in 1 month.
III. Treatment results
Through total thyroidectomy, lymph node dissection in the central region and tracheal sleeve resection, the lesion and the trachea it invaded were completely removed. Ultrasound and CT of the thyroid gland were reviewed 1 year after surgery, and no recurrence of undifferentiated thyroid cancer was seen in the neck. Through surgical treatment, the compression of the tumor on the trachea and esophagus was effectively relieved, which improved the quality of life and prolonged the patient’s survival.
IV. Notes
It is gratifying that the patient’s condition was controlled after surgical treatment. However, the malignancy of undifferentiated thyroid cancer is very high, and patients need to pay close attention to its recurrence and metastasis, and need to undergo follow-up radiotherapy and review in the outpatient clinic. In addition, undifferentiated thyroid cancer is still a difficult problem in the medical field. Patients need to undergo molecular testing early to select appropriate targeted drugs or chemotherapy to control the progression of tumor and prolong survival time.
V. Personal insight
It is important to pay attention to thyroid self-examination and be alert to the presence of undifferentiated thyroid cancer if there is a rapidly growing neck swelling. These diseases are characterized by rapid tumor growth, high malignancy and short survival time. Patients can undergo pathological examination in regular hospitals to confirm the diagnosis. For undifferentiated thyroid cancer, comprehensive treatment such as radiotherapy, chemotherapy, and targeted therapy is currently provided on the basis of comprehensive evaluation and molecular testing. If surgery is possible and patients and their families have a strong will, surgery is preferred to relieve the pressure of tumor on trachea, improve patients’ quality of life and prolong their survival time.