Table 1.
Clinical course
| Case 1 |
Primary tumor
|
Follow-up (time since initial presentation)
|
|||
|---|---|---|---|---|---|
| Initial presentation | First recurrence (7 years) | Second non-thyroid primary (8 years) | Second recurrence (14 years) | Last follow-up (17 years) | |
| Clinical presentation | 2.9 cm Right thyroid mass with ETE and tracheal invasion | 0.7 cm Right neck subcutaneous/soft tissue nodule | Bilateral lung nodules; the largest 2.6 cm (RUL) | 0.3 cm and 0.4 cm Right neck subcutaneous/soft tissue nodules | NED-thyroid related; enlarging lung nodules |
| Laboratory tests | Undetectable serum TG; elevated serum TSH (88.05 microU/ml) | Low serum TG (0.4 μg/l); negative thyrogen-stimulated TG assay | Undetectable serum TG | Undetectable serum TG | Undetectable serum TG |
| Original pathologic diagnosis | Moderately differentiated PTC | Metastatic PTC | Metastatic adenocarcinoma, favor primary pulmonary origin | Metastatic carcinoma of probable salivary gland origin arising in salivary gland rests adjacent to thyroid or minor salivary glands adjacent to trachea | Adenocarcinoma of lung, bilateral, right (6.6 cm) and left (1.8 cm) lung (second primary tumor) |
| Revised pathologic diagnosis | MASC of thyroid | Metastatic MASC of thyroid | Metastatic adenocarcinoma, favor primary pulmonary origin | Metastatic MASC of thyroid | Adenocarcinoma of lung, bilateral, right (6.6 cm) and left (1.8 cm) lung (second primary tumor) |
| Stage | T4 N0 MX | ||||
| Treatment | Total thyroidectomy and RAI (200 mCi), THRT | Surgical excision, THRT | Close observation and follow-up with CT scan,THRT | Surgical excision, THRT | SBRT for lung adenocarcinoma, THRT |
| Case 2 | Initial presentation | First recurrence (4 years) | Second recurrence (13 years) | Third recurrence (14 year) | Last follow-up (14 years 10 months) |
|---|---|---|---|---|---|
| Clinical presentation | 7.0 cm Left thyroid mass with ETE and enlarged left neck LN | Enlarged residual left neck LN | 2.1 cm Left neck subcutaneous/soft tissue nodule (FDG avid/PET positive) | Enlarging residual left neck LN | AWD; Enlarged residual left neck LN |
| Laboratory tests | Low serum TG | Undetectable serum TG, negative Thyrogen-stimulated TG assay, negative RAI scan | Undetectable serum TG | Undetectable serum TG | Undetectable serum TG |
| Original pathologic diagnosis | Well-differentiated PTC with tall cell features; metastatic carcinoma to 6 of 23 LN, with ENE | Metastatic PTC with tall cell features, in 14 of 50 LN, with ENE | Metastatic carcinoma, similar to prior thyroid carcinoma, possibly of salivary gland origin, with MASC-like features | NA | NA |
| Revised pathologic diagnosis | MASC of thyroid | Metastatic MASC of thyroid | Metastatic MASC of thyroid | NA | NA |
| Stage | T3 N1B MX | ||||
| Treatment | Total thyroidectomy with limited left neck LN dissection, RAI (200 mCi); THRT | Modified left neck LN dissection; EBRT (6300 cGy), THRT | Surgical excision, THRT | Observation, THRT | Considered for clinical trial with NTRK3 inhibitor, THRT |
| Case 3 | Initial presentation | Last follow-up (2 years) |
|---|---|---|
| Clinical presentation | 6.5 cm Isthmic thyroid mass with ETE and tracheal invasion | NED |
| Laboratory tests | NA | NA |
| Original pathologic diagnosis | Outside pathologist #1: Poorly differentiated carcinoma, favor PTC; Outside pathologist #2: Metastatic papillary ductal carcinoma consistent with breast origin, associated with PTC; MSKCC pathologist: MASC probably arising from salivary gland rests in the perithyroid tissue colliding with an infiltrative PTC, follicular variant | NA |
| Revised pathologic diagnosis | MASC of thyroid | NA |
| Stage | T4 N0 MX | NA |
| Treatment | Total thyroidectomy; RAI,THRT, IMRT (6 months post operative) | THRT |
AWD, alive with disease; EBRT, external beam radiation therapy; ENE, extranodal extension; ETE, extrathyroid extension; IMRT, intensity modulated radiation therapy; LN, lymph nodes; MASC, mammary analog secretory carcinoma of salivary gland; NED, no evidence of disease; PTC, papillary thyroid carcinoma; RAI, radioactive iodine; RUL, right upper lobe; SBRT, stereotactic body radiation therapy; TG, thyroglobulin; TSH, thyroid-stimulating hormone; THRT, thyroid hormone replacement therapy.