Clinical analysis of 13 cases of primary squamous-cell thyroid carcinoma

Abstract

Objective: To analyze the clinical features, ultrasonographic manifestations, pathological features, treatment and prognosis of primary thyroid squamous cell carcinoma (PSCTC) and summarize the experience in diagnosis and treatment of this condition.

Methods: A retrospective analysis was conducted on patients who were admitted to Zhejiang Cancer Hospital from 2007 to 2021 due to thyroid nodules or thyroid malignant tumors that were ultimately confirmed by postoperative pathology as primary thyroid squamous cell carcinoma. We summarize the general situation, clinical information, laboratory examination, ultrasonic image characteristics, pathological examination, clinical treatment and prognosis of the patients.

Results: PSCTC is most often seen in older men and progresses rapidly. In laboratory tests, some patients had elevated levels of tumor markers (CA199, squamous cell carcinoma antigen level), thyroglobulin levels and tumor-related substances, but all these indicators lacked specificity. The ultrasound features of PSCTC are mainly hypoechoic, hard, substantial nodules with gross borders and a grade 1-2 blood flow signal, sometimes with signs of necrosis and calcification. In terms of treatment, PSCTC is mainly surgically resected, though some patients in this study underwent iodine-131 radiation therapy, local radiotherapy, and chemotherapy with unclear results. None of the patients survived for very long after treatment, but the prognosis of patients with highly differentiated squamous carcinoma was significantly better than that of patients with poorly differentiated squamous carcinoma. Papillary thyroid carcinoma may be one of the causes of PSCTC.

Conclusion: PSCTC is a malignant tumor with high malignancy and rapid clinical progression. Treatment options are mainly based on surgical resection and can be supplemented with radiotherapy and chemotherapy, but there is still a lack of a standardized treatment management system, and more cases and reports are needed to accumulate data.

Keywords: pathological features; primary squamous-cell thyroid carcinoma; thyroid; thyroid carcinoma; ultrasound.

Figure 1

(A) large nodule with internal necrosis. (B) there is a large, eggshell-like calcification on the surface of the nodule; information on the interior is not accessible. (C) metastatic lymph nodes appear like beads on the left side of the neck. (D) there is a large calcification inside the nodule and CDFI shows a grade 2 blood flow signal.

Figure 2

ultrasound images of patient #2, showing a hypoechoic nodule with indistinct borders in the left lobe of the thyroid gland, which was clearly visible as a nodule breaking through the thyroid peritoneum and invading the surrounding tissue. The patient underwent surgery only and had a survival period of 2 years and 7 months. (A) Sagittal scan (B) CDFI (C) Transverse scan (D) Elastography.

Figure 3

Ultrasound images of patient #5 in which normal thyroid tissue is no longer visible. The nodule occupies the entire image, with annular calcifications visible within it and a relatively rich local blood flow signal of RI=0.7. This patient had a recurrence 2 months after surgery, was treated with radiation after a second operation and was finally lost to follow-up. (A) Sagittal scan (B) Transverse scan (C) CDFI (D) Pulsed doppler.

Figure 4

ultrasound images of patient #4 showing a hypoechoic nodule, which appears to be lobulated, in the lower pole of the right lobe of the thyroid gland, with punctate calcifications visible within. CDFI shows a grade 1 blood flow signal. The patient’s postoperative pathology was that of a highly differentiated squamous carcinoma, which has not recurred to date. (A) Lateral scan (B) Sagittal scan (C) "Firefly" technique (D) PDI.

Figure 5

Pathological images of PSCTC. (A, B) 100×, (C, D) 400×.

Figure 6

Treatment and outcomes for patients with PSCTC.

Figure 7

CT images of patient #12. (A, B) are from August 2019, and (C, D) are from December 2019. This patient suffered a rapid enlargement of the right upper cervical and mediastinal lymph nodes in just 4 months and died in December 2019.