Anaplastic thyroid cancer pathophysiology

Anaplastic thyroid cancer Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Anaplastic thyroid cancer arises from cells of the thyroid, which are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3). Anaplastic thyroid tumor is always considered as stage IV. Genes involved in the pathogenesis of follicular thyroid cancer include P53 and BRAF.

Pathogenesis

• Anaplastic tumors have a high mitotic rate and lymphovascular invasion. It rapidly invades surrounding tissues (such as the trachea). The presence of regional lymphadenopathy in older patients in whom needle aspiration biopsy reveals characteristic vesicular appearance of the nuclei would support a diagnosis of anaplastic carcinoma. Most cases of anaplastic thyroid cancer have distant metastasis at the time of diagnosis because of the rapid growth and aggressive nature of this type of cancer. Common sites of metastasis include the lungs, pleura, bones, and brain.
• It is always considered as stage IV.

Genetics

• Mutation of P53 tumor suppressor gene is associated with anaplastic thyroid cancer.
• Mutation of BRAF gene is also associated with anaplastic thyroid cancer.

Associated Conditions

• Papillary thyroid cancer

Gross Pathology

• Unencapsulated, fleshy, tan-white tumor
• Soft-tissue infiltration of the neck

Microscopic Pathology

• Three types of histologic variety

• Spindle
• Giant cell
• Squamoid cell

Features:

• Cytologically malignant:
  • Huge nuclear-cytoplasmic ratio
  • Mitoses
• Presence or absence of necrosis

Immunohistochenistry

• Anaplastic thyroid cancer may be positive for the following markers:
  • Pankeratin (AE1/AE3)
  • High molecular weight keratins
  • TTF-1
  • PAX8
  • P53
  • B-catenin

• 
  Anaplastic thyroid carcinoma with a component of PTC. (WC)