1. Tissue, tissue and more tissue is the issue Inpatient wards case presentation No financial disclosure Dean Keller MD May 9 th, 2007

2. FNA Reports  Feb1-Right thyroid nodule consistent with papillary carcinoma  Feb 5-Right neck lymph node consistent with metastasis of anaplastic thyroid carcinoma  Feb 8-Right and left thyroid consistent with anaplastic thyroid carcinoma

3. Objectives  When a piece of clinical information does not fit the patient, go back to the patient and reevaluate  Understand that 20 to 30% of patients with anaplastic thyroid cancer can have coexisting differentiated thyroid carcinoma  Brief overview of anaplastic thyroid carcinoma

4.  Aggressive tumor  Patient in an older age population  Papillary carcinoma can coexist with more lethal thyroid cancers, may need additional biopsies of several sites for proper diagnosis Papillary carcinoma alone did not fit this patient’s presentation

5. Antecedent thyroid disease  20% of patients with anaplastic thyroid disease have a history of antecedent differentiated thyroid carcinoma  20-30% have coexisting differentiated carcinoma  Majority of synchronous tumors are papillary carcinomas  Hypothesis-anaplastic carcinoma develops from more differentiated tumors as a result of loss of p53 suppressor protein

6. Anaplastic thyroid carcinoma  Extremely aggressive with a mortality approaching 100%  2% of all thyroid cancers, mean age 70 yr  Rapidly enlarging neck mass with compression of aerodigestive tract and metastasis  Surgery and RT for palliation  ATC is a lethal malignancy with no improvement in outcome during 50 years