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Surgical Treatment of Large Neglected Tall-Cell Thyroid Papillary Cancer with Neck Skin Infiltration and Exulceration: A Case Report and Literature

Goran Zoric, Ivan Paunovic, Aleksandar Diklic, Nevena Kalezic, Biljana Certic, Vesna Rakic, Katarina Tausanovic, Bosko Odalovic and Vladan Zivaljevic

Background: To present for the first time a clinical case of a patient with giant neglected and exulcerated tall-cell papillary thyroid cancer, who was surgically treated.

Methods: We report a case of a 73-year-old woman with large firm infiltrated and exulcerated anterior neck tumefaction (12 cm in diameter) clinically suspected as anaplastic thyroid cancer. Patient had a goiter for more than 20 years with rapid growth in last months, after that presented with infiltration and exulceration of the skin.

Results: Fine needle aspiration biopsy (FNAB) revealed papillary thyroid cancer (PTC). Total thyroidectomy with en-block dissection of the infrahyoid muscles and skin was performed. Lymph node metastasis were not present. Pathologically, goiter and tall-cell papillary carcinoma were present without anaplastic dedifferentiation. Postoperative radioiodine therapy was done, than L-thyroxin suppressive therapy, patient refused transcutaneous radiotherapy. Serum thyroglobulin was 0.15 ng/ml. Vocal cord paralysis and hypocalcaemia were not present. In following 3 years patient did not come to postoperative control, then she came with local recurrence of disease and tracheostomy. Tumor reduction was a second operation which was performed. Pathologically, it was tall-cell papillary carcinoma with regional lymph node metastases. The skin defect was reconstructed with a local transpositional flap. Patient refused radioiodine and transcutaneous radiotherapy and died 4 years after first operation, she was 77-years old.

Conclusions: Skin infiltration and exulceration are rare in papillary thyroid cancer but they can be found in patients with neglected and poorly differentiated papillary carcinomas. Exulcerated tall cell papillary carcinoma can be unpredictable even in radically performed operation.