Collision tumor of the thyroid: follicular variant of papillary carcinoma and squamous carcinoma

Abstract

Background: Collision tumors of the thyroid gland are a rare entity. We present a case of a follicular variant of papillary carcinoma and squamous carcinoma in the thyroid. To the best of our knowledge, this is the first documentation of a collision tumor with a papillary carcinoma and a squamous carcinoma within the thyroid gland. The clinicopathological features and immunohistochemical profile are reported. The theories of origin, epidemiology and management are discussed with a literature review.

Case presentation: A 65 year old woman presented with a large thyroid swelling of 10 years duration and with swellings on the back and scalp which were diagnosed to be a follicular variant of papillary thyroid carcinoma with metastasis. Clinical examination, radiology and endoscopy ruled out any other abnormality of the upper aerodigestive tract. The patient was treated surgically with a total thyroidectomy with central compartment clearance and bilateral selective neck dissections. The histopathology revealed a collision tumor with components of both a follicular variant of papillary carcinoma and a squamous carcinoma. Immunohistochemical analysis confirmed the independent origin of these two primary tumors. Adjuvant radio iodine therapy directed toward the follicular derived component of the thyroid tumor and external beam radiotherapy for the squamous component was planned.

Conclusion: Collision tumors of the thyroid gland pose a diagnostic as well as therapeutic challenge. Metastasis from distant organs and contiguous primary tumors should be excluded. The origins of squamous cancer in the thyroid gland must be established to support the true evolution of a collision tumor and to plan treatment. Treatment for collision tumors depends upon the combination of primary tumors involved and each component of the combination should be treated like an independent primary. The reporting of similar cases with longer follow-up will help define the epidemiology, biology and establish standardized protocols for treatment of these extremely rare tumors.

Figure 1

Follicular variant of papillary carcinoma of thyroid and squamous carcinoma in close juxtaposition with each other (H&E 200×).

Figure 2

Minimal intermingling of both the tumors at the interface area without transformation (H&E 200×).

Figure 3

Papillary thyroid carcinoma of the thyroid showing nuclear crowding, nuclear clearing and nuclear grooves (H&E 200×).

Figure 4

Nests of non keratinizing squamous cell carcinoma (H&E 200×).

Figure 5

Tumor cells with eosinophilic cytoplasm forming a pearl. Note the distinct cytoplasmic borders (H&E 400×).