Indian Journal of Endocrine Surgery and Research
Volume 16 | Issue 2 | Year 2021

Anaplastic Thyroid Carcinoma: Spot Diagnosis

Mahesh Hema Meti-Raghava1, Chitresh Kumar2

1All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

2Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

Corresponding Author: Chitresh Kumar, Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India, e-mail:

How to cite this article: Meti-Raghava MH, Kumar C. Anaplastic Thyroid Carcinoma: Spot Diagnosis. Indian J Endoc Surg Res 2021;16(2): 89–90.

Source of support: Nil

Conflict of interest: None


Though anaplastic thyroid carcinoma is a rare entity, it is very lethal. It is a surgical semi-emergency because it is rapidly progressive and once it breaches the thyroid capsule, it becomes inoperable. Therefore, every clinician should have a very low index of suspicion.

Keywords: Anaplastic thyroid carcinoma, Endocrine cancer, Thyroid cancer.

Anaplastic thyroid carcinoma (ATC) is a rare disease with very high mortality in contrast to the differentiated thyroid carcinomas that are more common and least aggressive among all thyroid cancers.1,2 Timely diagnosis and treatment is the key to save these patients but unfortunately till the diagnosis is made most of them are inoperable.24

We are presenting a clinical photograph (Fig. 1) of a 65-year-old lady who presented to us with history of slowly growing anterior neck swelling for past 20 years with rapid increase in size for 30 days along with difficulty in swallowing and breathing, loss of weight and appetite. On examination, we found that she was cachexic, having difficulty in breathing with hoarse voice. There was a hard-fixed, nontender, bosselated thyroid mass originating from right lobe, pushing the larynx and trachea to the left. There were dilated veins over mass and chest wall as well. The right sternocleidomastoid was splayed over mass. The over-lying skin was free with normal and pushed left lobe. The lower extent of the mass was going inside the thoracic inlet. We made a clinical diagnosis of undifferentiated or poorly differentiated thyroid carcinoma and advised a prompt fine needle aspiration cytology (FNAC) and contrast enhanced CT scan of neck and upper mediastinum. Unfortunately, she did not turn up for CT scan after undergoing cytology on the next day. The FNAC was suggestive of anaplastic thyroid carcinoma (Fig. 2).

Fig. 1: Labeled clinical photograph of an elderly cachexic lady with rapidly growing, hard and fixed thyroid mass

Fig. 2: FNAC smears showing polymorphic neoplastic cells with a necrotic background (Papanicolaou stain)

The causes of death in cases of ATC are usually respiratory failure (massive pulmonary metastasis), airway obstruction, bleeding, and circulatory failure.5


Chitresh Kumar


1. Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer 2016;23(4):313–322. DOI: 10.1530/ERC-15-0445.

2. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005;103(7):1330–1335. DOI: 10.1002/cncr.20936.

3. Chen J, Tward JD, Shrieve DC, et al. Surgery and radiotherapy improves survival in patients with anaplastic thyroid carcinoma: analysis of the surveillance, epidemiology, and end results 1983–2002. Am J Clin Oncol 2008;31(5):460–464. DOI: 10.1097/COC.0b013e31816a61f3.

4. McIver B, Hay ID, Giuffrida DF, et al. Anaplastic thyroid carcinoma: a 50-year experience at a single institution. Surgery 2001;130(6):1028–1034. DOI: 10.1067/msy.2001.118266.

5. Kitamura Y, Shimizu K, Nagahama M, et al. Immediate causes of death in thyroid carcinoma: clinicopathological analysis of 161 fatal cases. J Clin Endocrinol Metab 1999;84(11):4043–4049. DOI: 10.1210/jcem.84.11.6115.

© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.